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心動系實習商店WonderLand3/1~3/31預約表單
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* Indicates required question
Email
*
Your email
姓名
*
Your answer
系級 (師長請填xx系教師)
*
Your answer
性別
*
女
男
Other:
手機號碼
*
Your answer
有無舊傷，或慢性疾病，或曾手術過的身體部位
*
無
有
舊傷部位及發生時間、原因，或慢性疾病名稱及持續多久，或曾手術的身體部位
*
Your answer
是否有哪些身體部位不方便碰觸或不喜歡他人碰觸？(有則填身體部位，無則填無)
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Your answer
是否介意異性療癒師 ?(嬋柔器械運動、嬋柔墊上運動僅有女性療癒師)
*
是
否
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