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Edge Development Centre 服務問卷 Service Request Form (家長 Parent)
請家長完成以下問卷，以助心理學家了解孩子各方面的需要。
Please complete the following questionnaire to help psychologists understand your children’s needs.
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* Indicates required question
孩子個人資料 Personal Information (Child)
中文姓名 (Full Name Chinese) 以香港身份證明文件上為準
*
Your answer
英文姓名(Full Name English) 以香港身份證明文件上為準
*
Your answer
香港身份証/出生証號碼 HKID/ Birth Certificate Code
*
Your answer
性別 Gender
*
男 Male
女 Female
出生日期 Date of Birth
*
MM
/
DD
/
YYYY
住址 Residential Address
*
Your answer
出生地 Place of Birth
*
香港 Hong Kong
中國內地 Mainland China
澳門 Macau
Other:
到港年份 Year of Arrival in Hong Kong (如適用 If Applicable)
Your answer
就讀學校 School Attended
*
Your answer
班級 Grade/ Class
*
Your answer
學生編號 (STRN) Student Number
Your answer
轉介碼 Referral Code (如有 if any)
Your answer
聯絡人姓名 Contact Person's Name
*
Your answer
聯絡人電話 Contact Person's Number
*
Your answer
聯絡人電郵地址 Contact Person's Email Address
*
Your answer
與孩子的關係 Relationship with Child
*
父親 Father
母親 Mother
Other:
你從何得知本中心的服務? Where did you learn about our services?
*
網上搜尋器 Search engines
網上廣告 Online adverts
Facebook
Instagram
電郵 E-mail
學校 / 教師 / 親戚 / 朋友 Schools / Teachers / Relatives / Friends
Edge 講座（Zoom/YouTube)
Other:
Required
我不希望收到《Edgecation》心理教育通訊。I do not wish to receive the "Edgecation" psychological education newsletter.
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