国际研学报名表 APPLICATION FORM

一、请列出你的喜好与兴趣。Please indicate your hobbiesor interests:

 Rugby(橄榄球)Surfing(冲浪) Art(美术)   Reading(阅读) Watching movies(看电影)

 Baseball(棒球) Swimming(游泳)Photography(摄影) Aerobics(有氧运动)Listening to music’(听音乐)

 Tennis(网球)    Sailing(风帆)   Hiking(健行)         Dancing(跳舞)       Scuba diving(潜水)

 Golf(高尔夫球)Basketball(篮球) Fishing(钓鱼)      Soccer(足球)       Martial Arts(武术)

 Travel(旅游)     Cooking(烹饪)       Playing musical instruments(玩乐器)

Do you likeanimals(你喜欢动物吗):   Yes(喜欢)/No(不喜欢)

Pleasespecify by circling(请详细圈选):  Cat(猫)   Dog(狗)   Bird(鸟)   Fish(鱼)

二、你会如何形容你自己？How would you describe yourself?

 sociable(善于交际的)      positive(乐观的)       co-operative(合群的)        high achiever(高成就者)

 curious(好奇的)       cheerful(开朗的)      emotional(情绪化)   affectionate(重感情的) 

 nervous(紧张的)      quiet(安静的)           serious(严肃的)        shy (害羞的)

Other(其他)___________________________

三、你曾经离开家生活过吗Have you ever lived away from home before?

 yes(有)   no(没有)

四、你有对任何食物过敏吗Are you allergic to any food?

Please specify(请列出)_________________________________________

五、你有不喜欢的食物吗Do you have any food dislikes?

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六、你有任何健康与过敏的问题吗?Do you have any health problems? Any allergies?

Please specify(请列出)

______________________________________________________________________________________________

Do you take any medicine(你有服用任何药物吗)?     yes(有)              no(没有)

If yes, please give details(如果有,请详细列出):

_________________________________________________________

七、入住住宿家庭请补充填写以下信息

1、Wouldyou prefer a family with children(你喜欢有孩童的家庭吗)?

 yes(喜欢)   no(不喜欢)           either(皆可)

2、Do youhave any objections to pets(你讨厌有宠物的家庭吗)?

 yes(是)            no(否)

3、Do yousmoke(你吸烟吗)?

 yes(是)            no(否)       yes, but I will smoke outside(是,但我会在室外吸烟)

(Mostfamilies do not allow smoking in the house大多数的家庭是不允许在屋内吸烟)

4、Do youdrink alcohol(你喝酒吗)?yes(有)           no(没有)

八、家长对学员个人爱好，性格，生活习惯的评价以及对老师的嘱托。

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九、本人承诺：以上所提供的所有信息属实，并确保学员完全有能力独立参加研学营。

Student’s Signature(学生签名):...................................      Date(日期):..................

Guardian'sSignature(监护人签名):...................................    Date(日期):..................