Name
$ N4 y* b, X. ?! i% z3 ^0 e | " g$ y4 e+ s2 C6 O' i8 T
' [$ @% _4 K% k0 G4 |" D/ H w
| Gender
) x. A2 C/ Y- E, r | □Male □Female- ^! l3 _; d% A3 a+ e" V
|
Passport No.2 Q, C2 U7 i: R8 _; U ^
|
( J2 d; u% b+ t% Z) r+ ~1 D 2 X3 B8 p3 Z; u+ Q2 `2 h
| Date of Birth
2 T' `( C3 X* A2 g$ T1 n6 c | Year Month Day# |. g% a* L; f$ n) u' t- h
|
Telephone
, P2 z4 N' r/ r | (Mobile)& O5 f& d- O3 e d# ~" Q8 ?- P
| (Home)3 Y6 o9 Q: D5 F4 A& [8 H4 M7 g
| E-mail：
7 Q1 y/ L* D0 k/ J# }. z/ O/ R) d. I |
Fax
# m6 |$ A8 e' l1 P | + l4 p$ c; w: Q4 {& J2 ?
| Nationality
( L2 M1 W( I. K7 x | |
Name of School& P5 F1 q+ T+ W
| 6 }) k: R% H) [' @6 |6 o9 C8 i
| Major R4 r6 Y( M' L: x( x% k# X; b( l
| |
Address5 g# p; [% R1 p' o) L' K
| 5 z9 ^; R& S' U# v
|
Eating habits
% ^7 a. z* W6 K0 F0 ~; P | □Non-vegetarian
# @2 j# g9 r& `- V- v□Vegetarian
9 Z) X# y \( w T g7 T | Others： Requirements：8 R$ j5 u5 K& V) a* E* Z
|
Attending Stage: D( u# H I3 w2 e5 E7 y: Z- K# Q
| □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )5 U. v' n2 s: v8 ]9 e
□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)5 _! q" r, g! b; D+ W
|
Parents Information
5 I0 @7 N. a8 _ | Name of the parents% _" R; |' \# y0 R0 h% n9 D6 O
| □Agree
" M3 u+ m4 X h5 Y□Disagree) g- V8 `5 K" |9 c' \5 F4 J
5 r8 V# q! Q3 S | Date of Birth3 h# L+ h8 K. p' l) q" I
| Year Month Day+ d/ }# B3 _; p# I; t" o
|
ID No.
+ s+ n. s. O9 ?0 D | |
Parents Agreement
# z& u" i( C" t% H | Signature Date
3 N, |( h( l0 l. X' r |
Emergency Contact person
* h- n' [! Y7 C; s7 b | (Mobile)* l" c- y% ]4 W2 G/ l% }, j3 u
| (Home)
8 f! N1 s- }! ]' } | (Work), N6 `- \( }9 s/ E
| Relationship to Applicant) l0 _& R2 d' x1 K- v1 z3 W h! t
|
Comments | Note:
* J4 ?: E$ e8 X5 I5 i: ^& APersonal Belongings: Sleeping bag or quilt , Toilet articles (Tooth cup, Toothbrush, Toothpaste, Towel), Clothing, Slippers, Coat, Umbrella, Healthy insurance card, Personal medications and a good mood. 9 \! E8 q% t( h- |0 E% r
|
發表於 2012-5-21 09:03:55
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