PDF《填妥报名表后 Send the completed》

! 填妥报名表后 Send the completed enrolment form: n 传真 By Fax:

2326 0220或or

2242 2363 (请勿多次传送同一份报名表或在非办公室时间内传真.

Please do not send duplicated forms or fax at non-office hours.) n 邮寄 By Post: 九龙黄大仙沙田坳道110号地下至三楼「CCDC舞蹈中心」 CCDC Dance Centre, G/F to 3/F,

110 Shatin Pass Road, Wong Tai Sin, Kowloon 儿童舞蹈课程报名表 Children Dance Courses Enrolment Form 学生资料 Personal Details n 新生 New Student 如适用 If applicable 推介人 n 学员 Student Referrer' s Name: n 导师 Instructor 联络电话 已报读2019年第二期课程编号 Contact No: Have joined the 2nd

2019 course code: n 旧生 Current Student 曾经报读中心课程,旧生除非资料更改,否则只须填写有*的资料 Current student only needs to fill in field with* unless personal details have been altered *CCDC Kids Card 编号 No.:KC *有效日期 Expiry Date (日DD?/?月MM?/?年YY): / / *学员姓名 Name : (中文) *(English) 性别 Gender : *年龄 Age: n 3-4 n 5-7 n 8-10 n 11-12 住宅电话 Home Tel: 电子邮箱 E-mail: 家长或监护人姓名 Name of Parents or Guidance: 与学员之关系 Relationship: *紧急联络电话 Emergency Tel. No.: (#可接收SMS流动讯息Allow to receive SMS) * 以下填写资料以课程编号为准.Please note that the final decision on admission will be subject to the anthertication of course code as written on the table below. 课程资料 Course(s) Particular 课程编号* Course Code 课程名称 Course Name 上课时间 Time 折扣 Discounts 学费 Fee 1. HK$ 2. HK$ 3. 申请 / 续办 Apply for / Renew CCDC Kids Card 年费 Annual Fee HK$220 合共 Total: HK$ * 传真报名只接受信用卡付款.For fax enrolmrnt, payment should be made by Credit Card. 付款方法 Payment Method n 现金 Cash n 划线支票号码 Crossed Cheque No : 〔抬头支付 "城市当代舞蹈团有限公司"Payable to "City Contemporary Dance Co. Ltd" { n 信用卡 Credit Card: n VISA n MASTER *恒生Alpha Card 除外 Except for Hang Seng Alpha Card 持卡人姓名 Cardholder' s Name (英文 English) 有效日期 Expiry Date : 月MM / 年YY 信用卡号码 Credit Card No.CVV号码 CVV Code: **CVV号码乃卡背签名栏上右面最后三个号码 CVV code are the last

3 digits printed in the signature field on the reverse side of the credit card 签署 Signature (请用信用卡上之签名式样 Please use authorized signature as on your credit card) *同意书 Consent Details 1. 本人已细阅课程小册子内的 『报名须知』 并同意及遵守有关课程之一切安排.IconfirmthatIhavereadandagreetoabidethe "EnrolmentInformation" set by the office at the course leaflet. 2. 本人同意一切由CCDC所订下之条款及指引,并且督促本人之子女严格遵从.在参加任何课程时本人之子女如有任何特殊情况出现,如有损伤、疾 病或财物损失等,除证实为CCDC疏忽所引外,CCDC无须负上任何法律或金钱责任.I agree that me and my child will be bound by the rules and regulations set be CCDC. CCDC shall not be under any liability in respect of any injury of my child or damage to my property as a result of participation in any courses, and except any such injury or damage caused by the negligence of CCDC. 家长 / 监护人签署Signature of Parent / Guidance:日期Date: 办公室专用 For Office n 亲身报名 In Person n 传真报名 By Fax n 邮寄报名 By Mail n 银联 CUP n EPS (Ref. Date_n DIR n MSG n SMS n N/A) 收怕 Receipt No. 经手人 By 付款日期 Paid on 学员编号 Student No. (2nd 2019) PSI-