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2022-2023年度新生入學申請表 (Application Form for Admission in the 2022 - 2023 School Year)
香港中文大學校友會聯會
陳震夏幼稚園 (CUHK FAA CHAN CHUN HA KG) 順龍仁澤幼稚園 (CUHK FAA SHUN LUNG YAN CHAK KG)
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甲部：申請人資料 (Part A : Applicant’s Particulars)
電郵 Email
*
Your answer
中文姓名 Name in Chinese
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Your answer
英文姓名 Name in English
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Your answer
性別 Sex
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男 Male
女 Female
出生日期 Date of Birth
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MM
/
DD
/
YYYY
出生地點 Place of Birth
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Your answer
出生證明書號碼 Birth Certificate No.
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Your answer
年齡 Age
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Your answer
家中常用語言 Spoken language at home
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Your answer
住宅 電話 Home Telephone
Your answer
住址 Home Address
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Your answer
乙部：家長 / 監護人資料 Part B : Parent/Guardian’s Particulars
父親姓名 Surname and name of father
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如不適用請填 "NIL" If not applicable, Please specify "NIL"
Your answer
職業 Occupation
Your answer
聯絡電話 Telephone No.
Your answer
母親姓名 Surname and name of mother
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如不適用請填 "NIL" If not applicable, Please specify "NIL"
Your answer
職業 Occupation
Your answer
聯絡電話 Telephone No.
Your answer
監護人姓名 Name of Guardian
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Your answer
與學生關係 Relationship
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Your answer
聯絡電話 Telephone No.
*
Your answer
丙部：報讀資料 Part C : Applied Information
報讀校舍 Name of SchoolApplied For
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陳震夏幼稚園 CHAN CHUN HA KINDERGARTEN
順龍仁澤幼稚園 SHUN LUNG YAN CHAK KINDERGARTEN
第一選擇(首選) First choice
第二選擇(次選) Second choice
陳震夏幼稚園 CHAN CHUN HA KINDERGARTEN
順龍仁澤幼稚園 SHUN LUNG YAN CHAK KINDERGARTEN
第一選擇(首選) First choice
第二選擇(次選) Second choice
1.申請班級 Applying for Class
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幼兒班 (K1)
幼低班 (K2)
幼高班 (K3)
2.申請班級 Applying for Class
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上午班 A.M.
下午班 P.M.
全日班 Whole Day
第一選擇(首選) First choice
第二選擇(次選) Second choice
第3選擇(最後選擇) Last choice
上午班 A.M.
下午班 P.M.
全日班 Whole Day
第一選擇(首選) First choice
第二選擇(次選) Second choice
第3選擇(最後選擇) Last choice
現或曾就讀本幼稚園的兄弟姊妹（如適用） Particulars of Siblings attending or having attended this Kindergarten (if applicable)
(1) 姓 名 Name
Your answer
(1) 學 年 School Year
Your answer
(1) 班 級 Class
Your answer
(1) 關 係 Relationship
Your answer
(2) 姓 名 Name
Your answer
(2) 學 年 School Year
Your answer
(2) 班 級 Class
Your answer
(2) 關 係 Relationship
Your answer
(2) 關 係 Relationship
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