2020 春季班匯款＆健康及旅遊調查表單 Spring Payment & Student Health Traveling Form
本表所有資訊僅供Music Together Sandiano 課程報名之用，本單位恪遵個人資訊保密法，絕不將資料外洩。
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匯款帳號/ Banking Account Number
春季班學費, 請於官網報名註冊後，依照報名表的報名費繳費
或登入官網會員後，參考TUITION &FEE  (Register → Tuition / Fees )

SPRING Fee, Please settle your account balance as soon as you complete the registration form.
If you need further assistant, please contact us via email or line @mtsandiano  

銀行/Bank：008 華南銀行 信維分行
帳戶 /Account Number：1492-0059-7686 
戶名 /Account Name：楊惠如

匯款確認單填寫注意事項/ Notes
1.請填寫與官網報名註冊時「相同的mail」，才能順利對到您的款項。
2.若是有來自同一個家庭的孩子們，僅需填一份匯款單。
3.請確認您填寫的是匯款帳號的後5碼(存摺上帳號的後5碼)而不是提款卡上的後5碼喔！

*Please use the same email for both registration and payment form
*This form is use as per family purpose.
*The last 5 digits number shows on your banking book, not the banking card.
*Please provide your account name if you are wiring it via the bank.
 

**會計將在收到您的匯款單後，依據您填寫的資訊統一完成對帳，大約3-5天的作業時間，回覆匯款確認信到您的Email中/The payment confirmation email will send to you in 3-5 days.
Music Together Sandiano來自美國0-5歲親子音樂侓動課程
家長名字　Your Name *
聯繫的電子郵件 Email *
 *同報名表 same as your registration form*
手機　Phone *
第一位寶寶的名字 Child 1 Name *
（英文, 同報名表 same as the registration ）
第二位寶寶的名字 Child 2 Name  
（英文, 同報名表 same as registration ）
第三位寶寶的名字 Child 3 Name  
（英文, 同報名表 same as registration ）
銀行代碼  Bank Code *
(例如: 玉山銀行 808)
匯款帳號後 5 碼 Last 5 digits account number   *
(請確認是匯款帳號的後5碼，而不是提款卡上的後5碼)
匯款戶名 Account Name *
匯款日期 Transfer Date *
MM
/
DD
/
YYYY
匯款金額 Transfer Amount *
請選擇報名的班級/ Check the class you have signed up
請務必於下方選取您報名的班級
Rhythm Kids Level One 親子節奏 (4-6 years old)
(RK)大安教室1-欣締亞諾工作室-Da'An Studio 1 @ Sandiano Studio
(RK)大安教室2-蔚景幼兒園-Da'An Studio 2 @ OURS Preschool
Mixed Age & Baby Class 親子混齡班 (0-4 years old) & 寶寶班 (under 8 months old)
大安教室1-欣締亞諾工作室-Da'An Studio 1 @ Sandiano Studio
大安教室2-蔚景幼兒園-Da'An Studio 2 @ OURS Preschool
信義教室-樂幼屋-XinYi Studio @ Leo's Playland
天母教室1-童手創智體驗館-TianMu Studio 1 @ Graceful Hands Taiwan
天母教室2-得勝靈糧堂 ​​​​天母高島屋百貨-TianMu Studio 2 @ Victory Bread of Life Church at Dayeh Takashimaya
內湖教室-Oovi親子館-NeiHu Studio @ Oovi Swimming & Activity Center
Music Together Online 親子線上互動班
★因應新型冠狀病毒疫情,請報名家庭,配合填寫下方旅遊及健康狀況調查
MTS has been requested by the Taiwan central Epidemic Command Center (CECC) to collect students' travel history. All student [MUST] fill out the travel and healthy declaration form. Thank you very much for your corporation and understanding!

參與Music Together Online 的家庭，可跳過旅遊及健康狀況調查，謝謝。
If you are Music Together Online Family, Please skip the student health and traveling questions, thanks.
孩子及同住的家庭成員一個月內之旅遊狀況 Traveling history of you and your family member within 30 days
⚠️提醒您，依據衛生福利部疾病管制署規定，自3月19日起，所有自國外入境民眾，皆須配合居家檢疫14天。
Clear selection
請問是到哪一個國家? Which country you have visited in the category.
孩子及同住的家庭成員是什麼時後回到台灣? What dates did you or the above mentioned member of your household return to Taiwan?
MM
/
DD
/
YYYY
您或您的家中成員，是否曾在2020年2月1號後與確診新型冠狀病毒的患者接觸? /Have you or any member of your household ever been in contact with someone diagnosed with Coronavirus since 1 February 2020?
Clear selection
孩子及陪同上課的大人目前有以下任何症狀嗎? (可複選) Are you experiencing any of the following symptoms? ( check all the applies)
若有上述症狀是否有就醫診斷? Have you visited the doctors to get a diagnosis for the above mentioned symptoms?
Clear selection
填寫確認/ I hereby declare that the above information is true to the best of my knowledge.
Clear selection
我要留言 Comment
謝謝您完成填寫，若有任何問題請聯繫課務/ Contact us
musictogethersandiano@gmail.com 
LINE ID: @mtsandiano
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