上海维多利亚幼儿园(浦东).doc

幼儿照片Child’sPhoto上海维多利亚幼儿园(浦东)ShanghaiVictoriaKindergarten(Pudong)入学申请表StudentApplicationForm mencement:rade:(请于适当的空格内以√符号表示选择。Please√intheappropriateboxtoindicateyourchoice.)年级Grade双语Bilingual中文Chinese全日制Full-day半日制Half-day托小班BeeBeePlaylandN/AN/AN/A托班PreKN/AN/A小班K1N/A中班K2N/A大班K3N/A幼儿资料Child’sInformation中文姓名:ChineseName英文姓名:EnglishName出生日期:DateofBirth年YY月MM日DD性别Gender:国籍:Nationality民族/宗教:Religion幼儿身份证/护照号码:Child’sID/:HomeAddressinShanghai是否为产权房?PropertyRight是Yes否No户籍状态HouseholdRegisterCategories上海常住户籍ShanghaiResidence户口所在地址:外省市户籍OtherProvincesofChina幼儿临时居住证号码:家长居住证号码:香港HongKong澳门Macau台湾Taiwan外籍Expatriate家长资料ParentsInformation pany&’sHealthRecord曾有症状:MedicalHistory□抽筋Convulsion□哮喘Asthma□心、肺疾病Cardiovascular/PulmonaryDisease□血液病BloodDisease□onvulsion□脱臼dislocation是否食物过敏Anyallergytofood?□否No□是Yes食物名称Name:____________过敏程度Allergicdegree:□轻度Mild□中度Moderate□重度Severe是否药物过敏AnyallergytoMedicine?□否No□是Yes药物名称MedicineName:____________本人是否同意在意外或紧急时,园方把幼儿送往合适之医院就诊?identoremergency,IherebyauthorizetheSchooltosendmychildtotheappropriatehospitalfortreatment.□否No□是Yes本人同意幼儿如有不适或意外,可在本园卫生保健室治疗(急救包括小伤及擦伤)。ident,IherebyauthorizetheSchooltoadministerfirstaidtothischildintheSchool’smedicalroom(includingminorabrasionandwound).□否No