新西蘭學校申請表

1. Student Details 學生信息
Last name姓:
First name名:
Known as英文名:
Preferred name偏好名稱:
Date of birth出生年月日:
Age on arrival到達時年齡:
First language第一語言:
Other languages其他語言:
Country of birth出生國家:
Nationality現(xiàn)國籍:
Passport number護照號碼:
Passport expiry護照有效期至:
2. Father’s Details 父親信息
Last name姓:
First name名:
Occupation職業(yè):
Email電郵:
Date of birth出生年月日:
Mobile手機:
Passport number護照號碼:
Passport expiry護照有效期至:
Father’s address父親地址:
3. Mother’s Details母親信息
Last name姓:
First name名:
Occupation職業(yè):
Email電郵:
Date of birth出生年月日:
Mobile手機:
Passport number護照號碼:
Passport expiry護照有效期至:
Mother’s address母親地址:
4. Health Information健康信息
Please tick any conditions that affect you and indicate if you require medication for this condition. Please provide details below of any medication that you will bring with you.請?zhí)顚懸延械慕】蛋Y狀并告知相對應(yīng)需服用的藥品信息。
Asthma 哮喘（無/有，Medication 藥品）:
Back Injury 背部損傷（無/有，Medication 藥品）:
Mental Illness精神/心理疾?。o/有，Medication 藥品）:
Migraines 偏頭痛（無/有，Medication 藥品）:
Heart Condition 心臟問題（無/有，Medication 藥品）:
Eating Disorder 飲食失調(diào)（無/有，Medication 藥品）:
Epilepsy 癲癇（無/有，Medication 藥品）:
Vision Difficulty 視覺障礙（無/有，Medication 藥品）:
Glandular Fever 腺發(fā)熱（無/有，Medication 藥品）:
Stings 蜇傷（無/有，Medication 藥品）:
Hepatitis A or B 甲型肝炎或乙型肝炎（無/有，Medication 藥品）:
Diabetes 肥胖（無/有，Medication 藥品）:
Allergies 其他過敏（無/有，Medication 藥品）:
Food Allergies 食物過敏（無/有，Medication 藥品）:
Hearing Difficulty 聽力障礙（無/有，Medication 藥品）:
Any Other Medical conditions and any medication required (please list)其他任何醫(yī)療狀況及所需藥物（請列出）:
5. *Permission for Panadol是否同意攝取止痛片

For any conditions that you have ticked, please attach details that are relevant to the student while In New Zealand . Please also provide details of any medication or medical response that may be required; for example an Asthma Action Plan.如果你選擇了以上任意健康狀況，請?zhí)峁┫嚓P(guān)詳情并告知學校若發(fā)生病情后需采取的措施，例如哮喘病發(fā)措施。

*備注：Panadol 是一種常用的退熱和止痛藥物，常用于發(fā)燒、頭痛和其他輕微疼痛。它是許多感冒藥和止痛藥的主要成分。

6.

Vaccinations (please list OR provide a vaccination certificate in English):

疫苗（請?zhí)峁┣鍐位蛴⑽囊呙缃臃N證明）

7.

Vaccinations (please list OR provide a vaccination certificate in English):

疫苗（請?zhí)峁┣鍐位蛴⑽囊呙缃臃N證明）如有圖片，在此上傳

選擇文件
8.

Date received:

接種日期：

9.

Has the student had a Tetanus injection in the last 5 years? 

學生是否在最近5年有接種過破傷風？
10.

Has the student been in contact with any contagious diseases within the

last 3 months? 學生是否在最近三個月內(nèi)患有過傳染性疾?。?/legend>
11.

If yes, please give details:

如有，請?zhí)峁┰敿毿畔ⅲ?/span>
12.

Child’s Ability to Manage Emotions (Score from 1 to 10):

孩子控制自己情緒的能力，1~10打分

1 = Very poor emotional control; 10 = Excellent emotional regulation

1 = 情緒控制能力很差；10 = 情緒調(diào)節(jié)能力非常優(yōu)秀
13.

Parent’s Ability to Manage Emotions (Score from 1 to 10):

孩子控制自己情緒的能力，1~10打分

1 = Very poor emotional control; 10 = Excellent emotional regulation

1 = 情緒控制能力很差；10 = 情緒調(diào)節(jié)能力非常優(yōu)秀
14. Camp or Study Tour Experience 游學/營地經(jīng)歷

Have you previously participated in any summer camps on your own, either domestically or internationally? 是否獨立參加過夏令營，國內(nèi)國外均寫。若沒有請?zhí)睿篘/A

15. Learning Information 學習信息

Please provide details of any learning disability that may affect the student while in New Zealand School 請?zhí)峁┤魏慰赡茉谛挛魈m學校發(fā)生的學習障礙情況。若沒有請?zhí)睿篘/A

16.

Letter to the School給學校的一封信

In the space below, please write a short description of yourself and describe your family, your hobbies and your interests. Please also include some photographs that you would like to share. This information will be given to your school before you arrive to help them get to know you a little before you arrive.

請在以下空白處寫下自己和家人的信息、個人興趣愛好等。這些信息是為了讓學校在你抵達新西蘭之前對你有更多了解

Name of your School 你的學校名稱:
Are you coming with a friend? 你是否和朋友一起來的新西蘭？是或否 YES/NO.
Your friend’s name 若是，你朋友的名字:
Your personality你的性格是(e.g. cheerful開朗, outgoing外向, shy靦腆 etc等.):
What do you usually do in your free time?你一般在閑余的時間愛做什么？(e.g. shopping, fishing etc.購物、釣魚等)
What kind of books do you like reading and what tv shows interest you 你喜歡看什么類型的書或電視?。?adventure, comedy, non fiction etc.冒險類、喜劇類、紀實類)
What type of Music do you listen to and do you play an instrument? 你喜歡什么音樂？你是否會一門樂器？
What Sports do you enjoy? 你喜愛什么體育運動?
Future Profession? 未來想從事的工作?
Previous trips abroad是否去過其他國家:
Anything else you would like us to know 還有其他需要告訴我們的嗎?
17.

信息真實性及責任確認聲明

Declaration of Information Accuracy and Responsibility

本人已認真閱讀并確認以上信息真實有效，所填內(nèi)容均由本人如實提供。如因信息虛假、誤填、疏漏等問題造成的不良影響或損失，由本人承擔全部責任，與活動主辦方無關(guān)。

I have carefully read and confirm that all the information provided above is true, accurate, and complete. I acknowledge that I am solely responsible for any adverse consequences or losses resulting from false, incorrect, or omitted information, and such responsibility shall not be borne by the event organizer.

簽字人姓名（正楷）/ Full Name in Print:
與學生關(guān)系 / Relationship to Student:
聯(lián)系電話 / Contact Number:
簽署日期 / Date (YYYY/MM/DD) :
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