*Little Dreamers Playgroup *小小梦想家的开心乐园* Application Form* 报名表

 Little Dreamers Playgroup *小小梦想家的开心乐园* Application Form*报名表

Top of Form Contact Information/联系方式: Parents’ Name/家长姓名:

  

Home Address/住址:

 

City/城市:

 

State/省份:

Zip/邮编:

 

Parents’ Place of Employment/家长工作单位:

 

Emergency Contact Name & Number/紧急联系方式:

Email/邮件地址：

 

Extra Notes/ 备注 

Information on Child(ren)/学生信息:
	Last Name/姓	First Name/名	Date of Birth/出生日期 (mm/dd/yy)	Sex/性别 (M/F)
1.
2.
3.

Class Required/上课时间:
Select: Gz Oerlikon     May 2nd- July 25th 2013 (13 sessions)	English Playgroup/少儿英语课程 Thursdays 8:30-11:30 CHF 460 Chinese Playgroup/少儿中文课程 Thursdays 11:45-12:45 CHF 200 Both/两个都上 Thursdays 8:30-12:45 CHF 580
Select: GZ Schindlergut May 3rd-July 26th (13 sessions)	Chinese Playgroup/少儿中文课程 Fridays 13:15-15:15  CHF 390 English Playgroup/少儿英语课程 Fridays 15:30-17:30  CHF 390 Both/两个都上 Fridays 13:15-17:30  CHF 720

Signature家长签名:
Parent’s Guardian’s Signature/家长签名:
Date/日期:

Bottom of Form