Application Form Please fill in the form to apply for a playgroup course. After applying, you can bring the required payment(s) in person to: G/F #1 San Uk Tsai, Lam Tsuen, Tai Po Please note that fields marked with (*) are mandatory. Contents1 Child's information2 Program Selection3 Parent's Details: first parent4 Parent's Details: Second Parent Child's information Surname * Given name * Nick Name, English name Gender * Male Female Birth Date * Nationalities * Languages Spoken At Home Cantonese English Mandarin Others Other Languages, please specify Child's Home address (If more than one, list the address where the child spends MORE THAN 50% of time: * Child's Home address (If more than one, list the address where the child spends MORE THAN 50% of time: Child's Home address (If more than one, list the address where the child spends MORE THAN 50% of time: Child's Home address (If more than one, list the address where the child spends MORE THAN 50% of time: Town Town State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Who lives with the child at this address * Mother Father Helper/Auntie Grandparents OtherOther Child's medical information * N/A Asthma Allergies Other chronic conditions List all allergies Other chronic conditions, please specify Program Selection Desired Start Date * Selected Course * Bambinis: Morning ExplorersBambinis: Morning Lite 1Bambinis: Morning Lite 2Bambinis: Afternoon AdventurersBambinis: Afternoon LiteBambinis: Saturday Little ScientistIl Villaggio: Morning ExplorersIl Villaggio: Full Day FunIl Villaggio: Saturday Little Scientist Parent's Details: first parent Please enter the details for the first parent here. The account we will create for you on the web site to allow access to the parents/teachers area (Family Pages) will be created from the information entered for the first parent. In particular, make sure the email address is correct. Role * Mother Father Surname of first parent * Given name of first parent * English name of first parent Occupation of first parent * Email Address of first parent * Enter Email Confirm Email Address of first parent * Confirm Email Contact number of first parent * Parent's Details: Second Parent Role Mother Father Surname of second parent Given name of second parent English name of second parent Occupation of second parent Email Address of second parent Contact number of second parent
