Enrollment Form 報名表


Personal Details   學生個人資料               Please complete in BLOCK LETTERS   請用英文正楷填寫
*Surname
*Given Name
Other Name (e.g. Peter)
*姓名 (中文)
I.D. No. 身份證號碼
()
Date of Birth 出生日期 (dd/mm/yy)
/ /
*Gender
    M             F
*曾就讀港島英訊
    是           
*School Attending / Attended (English Name) 現就讀/曾就讀學校(英文全名)
*School Attending / Attended (Chinese Name) 現就讀/曾就讀學校(中文全名)
*Class 班別
Year of HKDSE
香港中學文憑考試年份

Contact Information   學生聯絡資料
*Address 住址
*Area 地區
HK 香港  Kln 九龍  NT 新界
Home Tel No. 住宅電話號碼
Mobile No. 手提電話號碼
Email Address 電郵地址

Parent Contact Information   家長聯絡資料
Surname
Given Name
姓 (中文)
名 (中文)
*Relationship 關係
Father 父親Mother 母親Guardian 監護人
*Mobile No. 手提電話號碼
Email Address 電郵地址

Class Information   課程資料
*Class Code
課程編號
*Class Name
課程名稱
*Date of First Lesson
開課日期(dd/mm)
*Number of Lessons
堂數
Date(s) of Absence
缺席日期

How do you know Island EM? (Please tick)      你怎樣知道港島英訊的? (請 ✓ )
朋友 / 同學介紹 父母 / 親友介紹 網站 港島英訊 Email
港島英訊課程單張 港島英訊舉辦的講座 報紙廣告
(報)
其他
(請說明: )

Declaration and Authorization

1.

I declare that all information given in this application form and the attached documents are, to the best of my knowledge, accurate and complete and that any false information or misrepresentation will disqualify my application for admission and enrolment.

2.
I authorize Island EM to use, check and process my data as required for my application to all courses which are held in Island EM. I accept that all the data in this form and those the courses are authorized to obtain will be used for purposes related to the processing and administration of my application in Island EM.

Please tick (✓) the right box if you do not wish to receive other future courses / events information from Island EM.