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星苗國際110學年度新生入學報名表 STAR Academy Application Form
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* Indicates required question
Email
*
Your email
學生姓名 - Student Name
*
Your answer
出生年月日 - Date of Birth
*
MM
/
DD
/
YYYY
身分證字號 - ID No.
*
Your answer
國籍 - Nationality
*
Your answer
性別 - Sex
*
男 ( M )
女 ( F )
通訊地址 - Current Address
*
Your answer
戶籍地址 - Permanent Address
*
Your answer
托育經驗 - Daycare Experience
*
Your answer
父親姓名 - Father's Name
*
Your answer
父親聯絡電話 - Father's Telephone
*
Your answer
父親信箱 - Father's E-mail address
*
Your answer
父親服務單位-Father's Company Name
*
Your answer
母親姓名 - Mother's Name
*
Your answer
母親聯絡電話 - Mother's Telephone
*
Your answer
母親信箱 - Mother's E-mail address
*
Your answer
母親服務單位-Mother's Company Name
*
Your answer
報名校區-Campus
*
縣政校區(竹北市縣政二路南段23號)
高鐵校區(二校新校區竹北市六家五路嘉豐南路口)
兩者皆可
Other:
報名班別 - Class
*
星星班 STAR 109/9 月以後
苗苗班 TOT 108/9/2~109/9/1
幼幼班(半美) Pre-K Pre-EMS 107/9/2~108/9/1
幼幼班(全美) Pre-K EMS 107/9/2~108/9/1
小班(全美) K1 EMS 106/9/2~107/9/1
中班(全美) K2 EMS 105/9/2~106/9/1
大班 (全美) K3 EMS 104/9/2~105/9/1
孩子的家中主要照顧者 Main Caregiver
*
父親 Father
母親 Mother
祖父母 Grandparent
外傭 Helper/ babysitter
其他 Other
家中排行 Siblings
*
獨生子 Only son
獨生女 Only daughter
老大 Eldest
老二 Second child
老三 Third child
其他 Other
孩子有無下列疾病 Medical Condition
*
無 None
先天性心臟病 Congenital Heart Disease
氣喘 Asthma
癲癇
蠶豆症 G6PD
過敏 Allergies
異位性皮膚炎 Eczema
胃食道逆流 GERD
其他 Other
Required
孩子有無需要特別留意的身體狀況 Special Conditions
*
無 None
有 Yes
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