暑期異國舞蹈親子班報名表

Application Form 課程報名表

* Required 必須填寫

Child English First Name 小朋友英文名字*

Child English Surname小朋友英文姓氏*

小朋友中文名 Child Chinese Name (Optional)

ChildreBirth Date 小朋友出生日期

Parent English Full Name同行家長英文姓名＊

同行家長中文姓名 Parent Chinese Name (Optional)

Parent Contact Phone (can use Whatsapp)家長聯絡電話 (可用Whatsapp)＊

E-mail 電郵

Relationship 關係

Emergency Back Up Contact Phone 緊急後備聯繫電話＊

Course Enroll 報讀課程: (Can pick more than one 可選多於一個)

1) Summer Belly Dance Parent/Child Class暑期肚皮舞親子班: 22/7, 29/7, 5/8, 12/8 (Sat六) 9:45am-10:45am

2) Summer Indian Bollywood Dance Parent/Child Class A暑期肚皮舞親子班 Class A: 22/7, 29/7, 5/8, 12/8 (Sat六) 2:30pm-3:30pm

3) Summer Indian Bollywood Dance Parent/Child ClassB暑期肚皮舞親子班 Class B: 23/7, 30/7, 6/8, 13/8 (Sun 日) 9:30pm-10:30pm

4) Summer Hawaiian Hula Dance Parent/Child Class 暑期夏威夷舞親子班23/7, 30/7, 6/8, 13/8 (Sun 日) 10:45am-11:45am

Is it 2 Groups (2 Adult + 2 Children) join together? 是否2成人+2小朋友同行夏季親子班

Yes 是

No 不是

If Yes, please name another children full name. 如是, 請註明另外一名小朋友姓名

有其他任何問題想了嗎?（可沒有的）

Do you agree to receive our course information and promotion? 閣下是否同意接收我們有關課程及優惠資訊?

Yes 願意

No 不願意

I have read the Te and accept the terms and conditions in this agreement. *本人已閱畢及接受條款及細則

View Terms and Conditions 查看條款及細則

微訊: JiyaDance