Name/ i9 P- }* G5 K7 l
| # e c8 L, b0 J8 O0 T- ~
4 t; E5 X [% M
| Gender( U: \0 r4 G, b0 H& Z1 W% ?" M0 P
| □Male □Female- n( G4 U1 L6 r) `* E. e5 Q9 H3 w
|
Passport No.. ?( O6 q5 D8 s# Z* @' h3 \
| T: T4 A0 _2 P$ D
% M# z" Y1 Y6 F) R/ \6 h3 ?
| Date of Birth& i- `# J- u5 |3 p B! f' A
| Year Month Day4 w3 x9 k0 G" P/ v# ]( l; w
|
Telephone
% ?* Y: e! O2 V1 | | (Mobile)
9 d) Q# C4 j4 {8 u$ `' {1 s+ q | (Home)
9 g! B6 N) A! q; x! H | E-mail：/ Q0 _ P% f8 l c
|
Fax * A+ g5 q6 X3 _8 @: u' o
|
6 W2 v. l3 I! g. A" L2 M; A! X | Nationality
( Z" q1 D4 R2 y: p' H [+ i | |
Name of School
: I6 j6 V# l, ^0 i0 Q2 r |
9 c/ _/ w) `; {( u# y | Major
" A5 i3 A2 @. N5 }! t5 _# @2 \! h | |
Address
- n" A# |) [8 r( X! x/ ~: f; _ | ! R* M6 V9 }; |* @9 O& h& m
|
Eating habits
[& t2 l# X% Q) @5 h | □Non-vegetarian . P/ e* l% k8 }
□Vegetarian
8 C7 O8 i/ G! n, B. |5 H$ q | Others： Requirements：
6 F4 c8 [8 m$ J$ l' G5 l6 w |
Attending Stage& X1 H8 |4 I; E8 o
| □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )
6 r. u2 Z* s7 w□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)1 l" Q# F# [ k% ~' K1 c
|
Parents Information1 I* M/ m" n9 n1 P! i
| Name of the parents
R% O6 g8 C# f/ V( n+ M | □Agree
0 l7 `1 }5 ?' ?4 }5 ~6 ]" }□Disagree
# ?4 x; f7 S' x9 N3 x6 G% s, ^" e/ W ! h4 e; y2 }. o9 U. j2 N
| Date of Birth
( ?* P) i! H+ Y) p | Year Month Day& s1 _4 F9 r! b0 i; |! j; m( L6 R" q
|
ID No.
% \. q$ e2 E2 F4 s | |
Parents Agreement9 \2 G& n# D& G* z! _6 C- F1 s
| Signature Date
5 h. U* A$ e7 x$ j0 u( O |
Emergency Contact person
' \# n* F$ e4 i$ ~2 d0 w( t | (Mobile)5 i8 M8 @; \$ T1 p# G: C
| (Home)
, Q7 ` N5 N4 [! H- |+ l | (Work)# H* w, y: e" G# @- W
| Relationship to Applicant G0 j$ X2 D- N6 o" Y$ E7 u, ]
|
Comments | Note:
3 U& s! {7 e1 _+ s9 k7 L5 cPersonal 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. 6 H8 f. C$ [6 |
|
發表於 2012-5-21 09:03:55
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