TITLE

KinderU – 疫苗接種統計 Vaccination Statistics

請填寫所有將會陪同學生到中心上課的家長或監護人資料。
Please fill in the personal details of all accompanying adult(s).

學生姓名 Student's name *

電話號碼 Telephone no. *

(1) - 第一位監護人姓名 The first guardian/caregiver's name *

(1) - 第一位監護人與學生的關係 Relationship between the first guardian/caregiver and the student *

(1) - 是否已接種第一劑新冠疫苗？Has the first guardian/caregiver received at least one dose of the COVID-19 vaccine? *

(2) - 第二位監護人姓名 The second guardian/caregiver's name

(2) - 第二位監護人與學生的關係 Relationship between the second guardian/caregiver and the student

(2) - 是否已接種第一劑新冠疫苗？Has the second guardian/caregiver received at least one dose of the COVID-19 vaccine?

(3) - 第三位監護人姓名 The third guardian/caregiver's name

(3) - 第三位監護人與學生的關係 Relationship between the third guardian/caregiver and the student

(3) - 是否已接種第一劑新冠疫苗？Has the third guardian/caregiver received at least one dose of the COVID-19 vaccine?

備註 Remarks

Website

Address:	UG/F, Tower 26-28, South Horizons, Phase 4 Ap Lei Chau, Hong Kong (behind sound barrier on Lei Nam Road)
Tel:	(852) 2554 7576
Fax:	(852) 2875 0454