2022-2023都柏林少儿孔子学堂（兴趣班）新生报名表 2022-2023 New Students Registration Form ( Extra-curricula Course ) of Dublin Confucius Class for Children

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注意Note：
1. 请家长和学生在注册和缴费时使用同一个邮箱和联系电话。Please use same email address and contact number when making registration and payment.
2. 以上信息仅作为少儿孔子学堂报名登记使用，不会泄露给其他机构。The above information is only used as registration for UCD Confucius Institutes Children's Classes and won't be disclosed to other agencies.

Email *

学员英文名及中文名（如有）Applicant's full name and Chinese name (if has) Eg. John Wang ( 王一） *

性别 Gender *

女Female

男Male

出生日期 Date of birth *

YYYY

家长/监护人姓名 Parents/Guardian's Full name

18岁以下学生需要填写 Students under 18 required

与学员关系 Relationship with Applicant

18岁以下学生需要填写 Students under 18 required

家长/监护人联系电话 Phone Number of Parents/Guardian

18岁以下学生需要填写 Students under 18 required

家长/监护人邮箱 Email Address of Parents/Guardian

18岁以下学生需要填写 Students under 18 required

紧急联系人电话 Emergency Contact number *

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