Your form has been submitted successfully!

Student's Name:


Date of Submission:


Time of Submission:


Payment Methods:

1. Cash Payment / Cheque Payment / EPS at School Office.

2. Cash Deposit / Cheque Deposit to the Bank Account below.
    Please fax the Pay-in Slip & duly completed Enrollment Form to 2513 0459 after payment.

3. Cheque Payment & duly completed Enrollment Form by post to School (address below).


1. 親臨本校,以現金 / 支票 / EPS 付款。

2. 存入現金 / 支票至以下銀行帳戶,並傳真存款單及填妥的報名表至 2513 0459。

3. 以支票連同填妥的報名表格郵寄至本校(地址如下)。

Bank Account Details 銀行帳戶資料

Bank Name: China Citic Bank International
Bank Code: 018
Account Name: English Medium Education Company Ltd
Account Number: 713-1-170933

Mailing Address 郵寄地址

English Medium Education Company Ltd
3/F Yeung On Building
50-54 Shau Kei Wan Road
Sai Wan Ho
Hong Kong

香港西灣河筲箕灣道 50-54 號陽安大廈 3/F

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
*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)
/ /
    M             F
*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

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
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
*Class Name
*Date of First Lesson
*Number of Lessons
Date(s) of Absence

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
(請說明: )

Declaration and Authorization


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.

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.