課程報讀表格

1. 請填寫學生香港文姓名。 Please fill in the student's name in Hongkngese.

2. 請填寫學生英文姓名。 Please fill in the student's name in English.

3. 請填寫學生的出生年月（MM/YY）。 Please fill in the student's date of birth (MM/YY).

4. 請填寫一位家長/監護人的姓名。 Please provide the name of one parent/guardian.

5. 請填寫上述家長/監護人的聯絡電話(亦請開通whatsapp/signal賬號）。 Please fill in the contact number of the parent/guardian mentioned above (please also open a WhatsApp/Signal account).

6. 請填寫上述家長/監護人的電郵地址。 Please fill in the parent/guardian's email address above.

7. 請選擇意欲報名之地區。Please select the region you wish to register for.

Solihull

Stretford

Sutton

Reading

8. 學生有沒有食物敏感或特別飲食需求?如有，請列明；如沒有，請填「沒有」。 Does the student have any food allergies or special dietary needs? If yes, please specify; if no, please fill in “No”.

9. 學生有沒有須特別注意的健康或醫療狀況?（例如藥物敏感、哮喘、糖尿病、癲癇等）如有，請列明；如沒有，請填「沒有」。 Does the student have any health or medical conditions that require special attention? (e.g. drug allergy, asthma, diabetes, epilepsy, etc.) If yes, please specify; If no, please fill in "No

10.本人同意我的孩子參加由香港語文研習平台舉辦的語文課程，並已閱讀《兒童保護政策》。 I agree that my child may attend language courses organised by the Hong Kong Language Learning Platform and have received and read the Child Protection Policy.

本人明白及同意：

• 我的子女參加所有課堂安排的活動。 • 合資格的人員或會在有需要時為我的子女提供急救或尋求緊急醫療服務。

• 課堂或會進行錄影，用於機構內部教育用途，包括團隊觀課、導師表現評核及內部行政用途。 I understand and agree that: • My child participates in all scheduled classroom activities.

• A qualified person may provide first aid or seek emergency medical services for my child if necessary.

• Classes may be recorded for internal educational purposes, including team observation, instructor performance evaluation and internal administrative purposes.

12. 請勾選您同意的選項： Please tick the options you agree to:

我同意將孩子的照片及錄影用於教育及推廣用途，包括宣傳資料、手冊、社交媒體及香港語文研習平台官方網站。I consent to the use of my child’s photograph and video for educational and promotional purposes, including promotional materials, brochures, social media and the Hong Kong Language Learning Platform official website.

我不同意將孩子的照片及錄影用於教育及推廣用途，包括宣傳資料、手冊、社交媒體及香港語文研習平台官方網站。I do not consent to the use of my child’s photographs and videos for educational and promotional purposes, including promotional materials, brochures, social media and the official website of the Hong Kong Language Learning Platform.

13.（如有）請輸入其他家長的專屬推薦碼。成功使用閣下與該家長各可減免一堂£15學費。 (If any) Please enter another parent’s referral code. If successfully used, both you and that parent will each receive a £15 tuition fee waiver for one class.

留位費（成功報名後，學費將扣減留位費之費用）

£1