Baker & Bloom K1-K3 Programme Application Form

Baker & Bloom K1-K3 Programme Application Form 百卉 K1-K3幼稚園課程申請表格
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*
Legal Name of Student in Chinese (as shown in Passport/ID) 學生中文姓名 (與證件相同)

First NameLast Name
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
Please enter a valid phone number.
Anticipated Grade Level 入讀級別*
Year of Entry (e.g. 2023) 入讀學年*
B. Previous School 過往就讀的學校
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）
C. Other Information 其他資料
Languages Spoken at Home 在家使用的語言*
Number of Siblings 兄弟姐妹人數*

Information on Siblings (if any) 兄弟姐妹資料（如有）

	First	Second	Third
Full Name 姓名
Current School 學校
Date of Birth 出生日期

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 NameLast Name
Name of Father in Chinese 父親中文名*

First NameLast Name
Occupation 工作職位*
Phone 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 NameLast Name
Name of Mother in Chinese 母親中文名*

First NameLast Name
Occupation 工作職位*
Phone 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?*

YesNo
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。
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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?*

YesNo
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?*

YesNo
If yes, please provide details: 如有，請提供詳細資料:
Please share 1 -2 activities in which your child was involved with their peers or siblings. How did your child interact with them? 請簡單描述 1-2 項你的孩子跟同學、朋輩、或兄弟姐妹曾一同參與過的活動。你的孩子如何跟他人互動？*
Please share briefly about a routine activity you do with your child (eg. reading time, weekend activity) and describe how you and your child interact or communicate. 請簡單紀錄一次日常親子活動，如親子閱讀時間、週末活動，並分享你和孩子的相處或交流模式。*
Please upload students' recent school reports (if any) 請上傳學生近期成績單（如有）：

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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 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*

First NameLast Name
Signature of Parent / Guardian 家長／監護人簽署*

Clear
Date*

DayMonthYear
Date
Should be Empty:

Baker & Bloom K1-K3 Programme Application Form 百卉 K1-K3幼稚園課程申請表格

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

H. Further Information 更多信息

I. Declaration 本人聲明