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
Legal Name of Student in English (as shown on Passport/ID) 學生英文姓名 (與證件相同) ：*

First NameLast Name
Nickname / Preferred Name 暱稱*
Please type N/A if not applicable.
Legal 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：*

DayMonthYear
Home Address 住宅地址：*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number 住宅電話：
Anticipated Grade Level 入讀級別：*
Year of Entry (e.g. 2025/26) 入讀學年：*

Add a Second Student
Legal Name of Second Student in English (as shown in Passport/ID) 學生英文姓名：

First NameLast Name
Legal Name of Second Student in Chinese (as shown in Passport/ID) 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：

DayMonthYear
Anticipated Grade Level 入讀級別：
Year of Entry (e.g. 2025/26) 入讀學年：

Add a Third Student
Legal Name of Third Student in English (as shown in Passport/ID) 學生英文姓名：

First NameLast Name
Legal Name of Third Student in Chinese (as shown in Passport/ID) 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：

DayMonthYear
Anticipated Grade Level 入讀級別：
Year of Entry (e.g. 2025/26) 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(非申請人):

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

Where did you first hear about us? 請問你是透過什麼渠道首次接觸我們？*
School Channels 學校渠道

Bloom Website 百卉網頁School Social Media 學校社交平台 (Facebook/ Instagram/ LinkedIn/ WeChat 微信/ Xiaohongshu 小紅書）Newsletter/ Email 百卉通訊/ 電郵
Word of Mouth 口碑

Current Bloom Parent/ Student 百卉家長/ 學生Former Bloom Parent/ Student (Alumni) 前百卉家長/ 學生 (舊生)Bloom Teacher/ Staff Referral 百卉老師/ 職員轉介Friend/ Relative 朋友/ 親戚
Please state the full name of the Bloom parent/ student/ staff who referred you. 請列出推薦閣下的百卉家長/ 學生/ 教職員全名。
Agents & Partners 中介機構或百卉合作伙伴

Education Agent/ Consultant 教育中介/ 教育顧問Kindergarten Referral 幼稚園轉介Other Primary/ Secondary School Referral 其他中、小學轉介NGO/ Community Partner 非牟利機構/ 社區合作伙伴
Advertising & Media 廣告或媒體

Online Advertisement (Google/ Social Media Ads) 網上廣告 (Google/ 社交媒體廣告）Print Media (Newspaper/ Magazine) 印刷媒體（報章/ 雜誌）Outdoor Advertisement (Banner/ Poster) 戶外廣告 (橫額廣告/ 海報）
External Events 外界活動

Education Fair/ Expo 教育展覽Seminar or Workshop (at external venue) 講座或工作坊（非百卉校園舉行）
Other (Please specify) 其他 (請列明)
Have you attended any of the following Bloom events? (Select all that apply)*

Open Day 開放日ECS Day / Entrepreneurial Workshop 專題學習工作坊 / 創業工作坊Campus Tour 校園參觀Info Session (Online) 簡介會 (網上)Info Session (Offline) 簡介會 (線下)
Are you the applicant's parent, guardian, relative, or agent representative? 請問你是申請人的家長、監護人、親友還是中介機構代表？*
If you are an agent representative, please state the your full name. （Please put N/A if not applicable.）如果你是中介機構代表，請提供中介人姓名。(如不適用，請填 N/A）
Please state the full company name of your agency. （Please put N/A if not applicable.）請提供你的中介機構公司名稱。(如不適用，請填 N/A）
D. Parents' Particulars 家長資料
Name of Father in English 父親英文名:*

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

First NameLast Name
Occupation (if any) 工作職位:*
Mobile Number 手提電話：*

Country CodePhone 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 NameLast Name
Name of Mother in Chinese 母親中文名:

First NameLast Name
Occupation (if any) 工作職位:*
Mobile Number 手提電話:*

Country CodePhone 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
Does your child have any developmental, educational and/or medical needs? 學生是否有任何發展、學習和/或醫療需要?*

Yes 有No 沒有
If yes, please provide details. 如有，請提供詳細資料:
Has your child undertaken developmental or learning assessment? 學生是否有接受過發展或學習評估？*

Yes 有No 沒有
If yes, please provide the educational-psychology report or similar. All information provided will be kept confidential and used for internal purposes only. 如有，請提供相關評估報告。所有提供的資料將被保密，僅供校內部門使用。

Cancelof
Has your child received, been recommended to receive, or is receiving any special education services? 學生是否曾被建議接受、接受過、或正接受任何特殊教育服務？*

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

YesNo
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: Does your child have any developmental, educational and/or medical needs? 學生是否有任何發展、學習和/或醫療需要?

YesNo
If yes, please provide details. 如有，請提供詳細資料:
Second Student: Has your child undertaken developmental or learning assessment? 學生是否有接受過發展或學習評估？

Yes 有No 沒有
Second Student: If yes, please provide the educational-psychology report or similar. All information provided will be kept confidential and used for internal purposes only. 如有，請提供相關評估報告。所有提供的資料將被保密，僅供校內部門使用。

Cancelof
Second Student: Has your child received, been recommended to receive, or is receiving any special education services? 學生是否曾被建議接受、接受過、或正接受任何特殊教育服務？

Yes 有No 沒有
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?

YesNo
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: Does your child have any developmental, educational and/or medical needs? 學生是否有任何發展、學習和/或醫療需要?

YesNo
Third Student: If yes, please provide details. 如有，請提供詳細資料。
Third Student: Has your child undertaken developmental or learning assessment? 學生是否有接受過發展或學習評估？

Yes 有No 沒有
Third Student: If yes, please provide the educational-psychology report or similar. All information provided will be kept confidential and used for internal purposes only. 如有，請提供相關評估報告。所有提供的資料將被保密，僅供校內部門使用。

Cancelof
Third Student: Has your child received, been recommended to receive, or is receiving any special education services? 學生是否曾被建議接受、接受過、或正接受任何特殊教育服務？

YesNo
Third Student: If yes, please provide details: 如有，請提供詳細資料:
Third Student: Does your child attend any extra-curricula classes or activities outside of school? 學生有否參加校外的任何課程或活動?

YesNo
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:*

Cancelof
Please upload a recent family photo here. (optional) 請上傳一張近期的家庭照片。(可選)

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

Cancelof

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

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

Cancelof

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

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

Cancelof

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 us 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。
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 Application Form.
5. I have disclosed all relevant information, if any, about my child's educational needs and/or any SEN diagnosis or previous supports. If after enrollment it is discovered that information was not disclosed during the admissions process, Bloom reserves the right to restrict the admissions entry or withdraw the admissions offer.

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
5. 本人已遞交所有有關申請學生教育需求、任何特殊教育需要（SEN）之診斷或以往支援的資料。本人明白如有任何刻意隱瞞的資料，包括如在入學後發現入學過程中有未披露的信息，學校保留限制申請學生的入學資格或撤回錄取結果的權利。
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:*

MonthDayYear
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