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北加福智NSJ德育班報名表
上课时间：星期天早上10AM-12PM
上课地点：1334 Ridder Park Drive, San Jose, CA
咨询电话：培心學苑 (408)649-6489；阿唐 (408)666-6413
报名资格：4岁至12岁的儿童
开学日期：秋季九月八日，春季一月二十六日
每年学费：秋季報名者，一年學費為 $200 （第二个小孩 $180）
春季報名者，半年學費為 $100 （第二个小孩 $90）
由于名额有限, 若有缺额時会通知替补. 不便之处尚请见谅.
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* Indicates required question
Parent English Name
*
家长英文名字
Your answer
English Name
*
学生英文
Your answer
Student Chinese Name
学生中文
Your answer
Date of Birth
*
2010/11/9 生日
Your answer
Gender
*
性別
Choose
Female
Male
Parent Chinese Name
家长中文名字
Your answer
Emergency Contact Person
*
紧急联络人姓名
Your answer
Email Address
*
电邮
Your answer
Phone Number
*
联络电话
Your answer
Residential Address Zip Code
居住住址的邮政编码
Your answer
Emergency Contact Phone Number
*
紧急联络人电话
Your answer
Relationship of Emergency Contact Person and Student
*
紧急联络人与学生的关系
Father 父亲
Mother 母亲
Grandparent 祖父母
Other:
Volunteer Interests
*
可能承担的志愿者专长（有可能，请复选）
手工
歌咏
舞蹈
美术
游戏
故事
读经
课间点心时间义工
踏青/秋游义工
暑期露营义工
Other:
Required
Have your child attended our class before?
*
请问您孩子曾參加过德育班吗？
Choose
Yes
No
How do you know about our class?
*
请问您如何得知福智德育班？
微信
LINE
Facebook
Friend/Relative/亲戚朋友
Flyer/传单
Website/网站
Lamrim Class/广论班
Other:
Required
Any other info you would like us to know about your child?
eg. allergy info... 是否有过敏或其他应注意事项？
Your answer
If you attend the Lamrim Class, please note down your class.
您若是广论研讨班学员，请注明班级，
Your answer
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