Bloom KKCA Academy Application Form 申請表格

Bloom KKCA Academy Application Form 申請表格
A. Student's Particulars 申請學生資料
Name of Student in English (as shown in Passport/ID) 學生英文姓名 (與證件相同) ： *

First Name Last Name
Nickname / Preferred Name *
Please type N/A if not applicable.
Name of Student in Chinese (as shown in Passport/ID) 學生中文姓名 (與證件相同)：

姓名
I.D. Card No 身分證號碼： *
Nationality 國籍： *
Place of Birth 出生地： *
Date of Birth 出生日期： *

Day Month Year
Home Address 住宅地址： *

Street Address

Street Address Line 2

City
Home Number 住宅電話：
Anticipated Grade Level 入讀級別： *
Year of Entry (e.g. 2022) 入讀學年： *

Add a Second Student
Name of Second Student in English 學生英文姓名：

First Name Last Name
Name of Second Student in Chinese 學生中文姓名：

名姓
Second Student I.D. Card No 身分證號碼：
Second Student Nationality 國籍：
Second Student Place of Birth 出生地：
Second Student Date of Birth 出生日期：

Day Month Year
Second Student Anticipated Grade Level 入讀級別：
Second Student Year of Entry (e.g. 2022) 入讀學年：

Add a Third Student
Name of Third Student in English 學生英文姓名：

First Name Last Name
Name of Third Student in Chinese 學生中文姓名：

名姓
Third Student I.D. Card No 身分證號碼：
Third Student Nationality 國籍：
Third Student Place of Birth 出生地：
Third Student Date of Birth 出生日期：

Day Month Year
Third Student Anticipated Grade Level 入讀級別：
Third Student Year of Entry (e.g. 2022) 入讀學年：

B. Previous School 過往就讀的學校

List your previous schools, beginning with the most recent
Name of Current School 現時就讀學校： *
Other Schools Attended & Dates (if any) 其他以前就讀的學校及就讀日期（如適用）:

Second Student
Second Student's Current School 現時就讀學校：
Second Student's Other Schools Attended & Dates (if any) 其他以前就讀的學校及就讀日期（如適用）:

Third Student
Third Student's Current School 現時就讀學校：
Third Student's Other Schools Attended & Dates (if any) 其他以前就讀的學校及就讀日期（如適用）:

C. Other Information 其他資料
Languages Spoken at Home 在家使用的語言： *
Number of Siblings in Family 兄弟姐妹人數： *

Information about Siblings (who are NOT applying for Bloom) 兄弟姐妹資料(非申请):

	First	Second	Third	Fourth
Full Name 全名
Date of Birth 出生日期
Current School 現時就讀學校

You were referred by 推薦人： *
If you were not referred, how did you hear about us? 如果沒有推薦人，請問您是如何發現我們的？：
D. Parents' Particulars 家長資料
Name of Father in English 父親英文名: *

First Name Last Name
Name of Father in Chinese 父親中文名:

First Name Last Name
Occupation (if any) 工作職位: *
Mobile Number 手提電話： *
Please enter a valid phone number.
Office Number 公司電話：
Please enter a valid phone number.
Email Address 電郵地址： *
example@example.com
Name of Mother in English 母親英文名: *

First Name Last Name
Name of Mother in Chinese 母親中文名:

First Name Last Name
Occupation (if any) 工作職位: *
Mobile Number 手提電話: *
Please enter a valid phone number.
Office Number 公司電話:
Please enter a valid phone number.
Email Address 電郵地址: *
example@example.com
E. Additional Information 補充資料
Has your child ever been referred to or received outside services or assessments? 學生是否曾被轉介或接受過專業評估? *

Yes No
If yes, please provide details, and upload any relevant external reports. 如有，請提供詳細資料並上傳相關文件:
Please upload any relevant external reports. All information provided will be kept confidential and used in processing the enrollment only. 所有提供的信息將被保密，僅用於處理註冊。

Cancel of
Has your child received additional support or extension from school? 學生是否從學校獲得了額外的支持或延期? *

Yes No
If yes, please provide details: 如有，請提供詳細資料:
Does your child attend any classes or activities outside of school? 學生有否參加校外的任何課程或活動? *

Yes No
If yes, please provide details: 如有，請提供詳細資料:
Please name 2-3 books that your child has recently enjoyed (either read independently or listened to): 請列出學生最近喜歡的2-3本書（獨立閱讀或聽取): *

Second Student
Second Student: Has your child ever been referred to or received outside services or assessments? 學生是否曾被轉介或接受過專業評估?

Yes No
Second Student: If yes, please provide your child's details, and upload any relevant external reports. 如有，請提供詳細資料並上傳相關文件:
Second Student: Please upload any relevant external reports. All information provided will be kept confidential and used in processing the enrollment only. 所有提供的信息將被保密，僅用於處理註冊。

Cancel of
Second Student: Has your child received additional support or extension from school? 學生是否從學校獲得了額外的支持或延期?

Yes No
Second Student: If yes, please provide details: 如有，請提供詳細資料:
Second Student: Does your child attend any classes or activities outside of school? 學生有否參加校外的任何課程或活動?

Yes No
Second Student: If yes, please provide details: 如有，請提供詳細資料:
Second Student: Please name 2-3 books that your child has recently enjoyed (either read independently or listened to): 請列出學生最近喜歡的2-3本書（獨立閱讀或聽取):

Third Student
Third Student: Has your child ever been referred to or received outside services or assessments? 學生是否曾被轉介或接受過專業評估?

Yes No
Third Student: If yes, please provide details, and upload any relevant external reports. 如有，請提供詳細資料並上傳相關文件:
Third Student: Please upload any relevant external reports. All information provided will be kept confidential and used in processing the enrollment only. 所有提供的信息將被保密，僅用於處理註冊。

Cancel of
Third Student: Has your child received additional support or extension from school? 學生是否從學校獲得了額外的支持或延期?

Yes No
Third Student: If yes, please provide details: 如有，請提供詳細資料:
Third Student: Does your child attend any classes or activities outside of school? 學生有否參加校外的任何課程或活動?

Yes No
Third Student: If yes, please provide details: 如有，請提供詳細資料:
Third Student: Please name 2-3 books that your child has recently enjoyed (either read independently or listened to): 請列出學生最近喜歡的2-3本書（獨立閱讀或聽取):

F. Parent Statement 家長聲明
Please provide an anecdote of when your child was independent and a time when your child was collaborative. 請舉例說明一件您的孩子獨立完成的事以及一件孩子與他人合作的事。 *

Second Student
Second Student: Please provide an anecdote of when your child was independent and a time when your child was collaborative. 請舉例說明一件您的孩子獨立完成的事以及一件孩子與他人合作的事。

Third Student
Third Student: Please provide an anecdote of when your child was independent and a time when your child was collaborative. 請舉例說明一件您的孩子獨立完成的事以及一件孩子與他人合作的事。

Scenarios 模擬情境
Please let us know how you feel you would react as a parent and how your child/children would react if he/she/they were in the following scenarios 請讓我們知道在以下情況下，您以及您的孩子會如何反應：
1. Your child/children reacted physically to an argument with a peer. 您的孩子在與同伴的爭論中有肢體衝突。 *
2. A classmate acted in a mean manner towards your child/children during a group project. 在小組項目中，同學對您的孩子表現出刻薄的態度。 *
3. Your child/children encountered a difficult academic task that he/she/they must struggle through. 您的孩子需要完成一項艱鉅的學術任務。 *
4. Your child/children are performing below grade level in a given content area. 您的孩子在指定學習範圍內的成績低於年級水平。 *
G. Uploads 上傳資料
Please upload a recent photo of student here 請上傳一張學生的近期照片: *

Cancel of
Please upload school reports for the past two years 請上傳學生近兩年的成績單： *

Cancel of

Second Student
Please upload a recent photo of student here 請上傳一張學生的近期照片:

Cancel of
Please upload school reports for the past two years 請上傳學生近兩年的成績單：

Cancel of

Third Student
Please upload a recent photo of student here 請上傳一張學生的近期照片:

Cancel of
Please upload school reports for the past two years 請上傳學生近兩年的成績單：

Cancel of

H. Further Information 更多信息
Please feel free to share with us any additional information 請填入任何其他相關信息:
* Information provided will be used in processing the enrollment only. 申請人所提供的資料，只供處理申請時參考之用。

* If you have further questions regarding the application, please contact our Director of Admissions, Ms. Joyce Cowden, at admissions@bloom.edu.hk or call 2311-2268. 如果您有關於申請入學的問題，請發送電子郵件到 admissions@bloom.edu.hk 或致電 2311-2268 聯繫我們的招生總監，黃詠恩。
I. Declaration 本人聲明
1. I am the parent/guardian of the above-mentioned student.
2. I understand the purpose for which the personal data provided by means of this form will be used and my rights for data access/correction.
3. To the best of my knowledge and belief the information contained in this form is true and correct. If false information is supplied, this application will be rendered null and void.
4. I submit photocopies of all relevant documents (e.g. school report and any other report or referral from outside professional) with this Enrollment Form.

1. 本人為上述申請人的家長／監護人；
2. 本人明白此表格提供的個人資料的用途，和有關查閱及改正資料的權利；
3. 此表格內的資料全屬正確無訛，倘若有虛報資料，則本申請作廢；
4. 本人現隨申請表提交各有關證明文件之副本以供參考
Name of Parent / Guardian 家長／監護人姓名: *
Signature of Parent / Guardian 家長／監護人簽署: *

Clear
Date 日期: *

Month Day Year
Date
Should be Empty:

Bloom KKCA Academy Application Form 申請表格

A. Student's Particulars 申請學生資料

B. Previous School 過往就讀的學校

C. Other Information 其他資料

D. Parents' Particulars 家長資料

E. Additional Information 補充資料

F. Parent Statement 家長聲明

Scenarios 模擬情境

G. Uploads 上傳資料

H. Further Information 更多信息

I. Declaration 本人聲明