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庞弗雷特 S.T.E.A.M 暑校
名校体验营
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美东大学生英语文化研学营
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Part One: Student Information
*
Indicates required field
1. First Name:
*
2. Last Name:
*
3. Age
*
(Select One)
11
12
13
14
15
16
17
18
19
5. Date of Birth:
*
6. Grade:
*
(Select)
5
6
7
8
9
10
11
12
4. Gender:
*
(Select One)
Male
Female
Other
If "Other," Please Specify:
*
Part Two: Location
7. Address:
*
Line 1
Line 2
City
State
Zip Code
Country
8. Family Email:
*
9. Home Phone:
*
Part Three: Family Information
10. Guardian 1 Name:
*
12. Guardian 1 Cell Phone:
*
11. Guardian 1 Relationship to Student:
*
13. Guardian 1 Work Phone:
*
14. Guardian 1 Email:
*
15. Student Emergency Contact?
*
(Select One)
Yes
No
16. Guardian 2 Name:
*
18. Guardian 2 Cell Phone:
*
17. Guardian 2 Relationship to Student:
*
19. Guardian 2 Work Phone:
*
20. Guardian 2 Email:
*
21. Student Emergency Contact?
*
(Select One)
Yes
No
Part Four: Emergency Information
Note: If you have already indicated one or more guardians as the emergency contact, you may leave that information blank here
22. Emergency Contact Name:
*
24. Emergency Contact Email:
*
23. Emergency Contact Relationship to Student:
*
25. Emergency Contact Cell Phone:
*
26. Please indicate any allergies your child has (i.e. medications, food, bee stings, etc):
*
27. In the unlikely event of a medical emergency requiring medical attention, do you grant permission for the camp nurse or physician to attend to your child?
*
Yes
No
Part Five: Certification of Accuracy
Certification:
*
By checking this box, you certify that all information in this form is true and correct to the best of your knowledge.
Additional Comments or Questions (optional):
*
Submit
主页
关于我们
线上课程
ABC 全方位预备美国学习生活课程
4-5年级语言艺术
在线科研
未来领袖 谈判艺术
研学项目
研学项目
>
中美领袖营
庞弗雷特 S.T.E.A.M 暑校
名校体验营
商科实战演练营
美东大学生英语文化研学营
美西NASA太空探索营
柴郡学院 暑期STEAM夏令营
美西全真插班营
报名表
反馈表
留学规划
美高后续项目
服务内容
外教输出
项目简介
商务考察
联系方式
English