Name
) P% O+ @" ^ b+ W( n$ n | 2 Y6 L/ n5 }! c+ I1 }# H
+ G# k6 o8 N! R: ]. W" | | Gender8 @7 ~" ^. X; S1 }2 \
| □Male □Female. Z+ D9 P: Q- f k0 E c: T
|
Passport No.
' I3 R) w3 A9 u3 {& V/ E |
7 _' Y. }& P' D2 U! \ 5 z5 \ A8 H" W) P; D
| Date of Birth
N2 _! G' W7 r0 R7 u9 N | Year Month Day
9 h! [3 e9 a u |
Telephone 1 S) T6 F$ y" }$ p/ ~
| (Mobile)& j8 {" V. D) K7 N9 h: k5 l
| (Home)- ?5 a+ D# |; o, W, V
| E-mail：0 b4 M. h- K& g3 p7 O# H# k
|
Fax
% W0 a) C9 i" K; j# g+ U! r |
8 a4 x! u; \& c/ S | Nationality: [+ g0 k. i! w" a& g+ O
| |
Name of School8 G$ j1 `3 `: d9 {5 o
|
5 T7 E( M: h' e$ }# m | Major
% K% Q; S* c o0 i5 y$ ^- a | |
Address$ ?/ b: Y9 n4 |: R( D
| + l" {, g2 a4 d; ]. Y
|
Eating habits' E3 I; U6 w, C- @
| □Non-vegetarian
# y* _/ Z2 W( E! Y9 H4 p/ b□Vegetarian
- p! q4 |% |' {3 X: g; ]) Y2 q5 W | Others： Requirements：
+ x4 b3 w' k7 M3 S/ u* |% a |
Attending Stage
e/ T+ Q9 X2 ]' H5 a/ L5 v | □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )
8 w; ]. U' \" G' j5 g3 S□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)$ O& e/ m. n4 b# s3 c+ f, Z
|
Parents Information
5 X" g, J7 b D- s- n7 I: T | Name of the parents+ n. n' B; Y- y6 K/ H
| □Agree
( \5 ]& E8 v* H$ Y* ?□Disagree
) J/ D% r7 |: ~. Q
- i2 d$ u7 a' \: w9 a" C: L | Date of Birth
. n/ A- B) }4 H | Year Month Day
7 N4 {* w% [, K# Q# z( t& t |
ID No.4 D, l& d/ n, T) e y
| |
Parents Agreement
: b* E" N! e5 U0 z! {5 @6 m | Signature Date
: X' O+ g6 w$ J9 ^ g# R- y |
Emergency Contact person, Q( ?) d9 @4 m; o5 D! y
| (Mobile)
6 O1 |7 D5 ]2 Z* W) F | (Home) |1 w; ^' i7 ^8 e, I% Z
| (Work)
: [: R2 `( f% U | Relationship to Applicant9 x) J R( @8 l! Q, | c8 }7 a
|
Comments | Note:
% A, V* s' j( a+ m% N9 R6 F |5 ZPersonal 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.
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發表於 2012-5-21 09:03:55
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