WMI Education | www.WMI-Education.com | www.facebook.com/wmi.education Unit 903, Park Commercial Building, 180 Tung Lo Wan Road, Hong Kong Tel: +852 2325 9000 | Fax: +852 2325 9019 | [email protected] www.WMI-Education.com Enrollment Form for WMI Programs Enrolment is first come first served. Due to limited spaces, spots will only be secured when full payment is received. Personal Information * Student’s Name: 學生姓名： Date of Birth: (dd/mm/yy) Gender: (M/F) Native Language(s): Home Tel: Parent’s Name #: Email: Mobile: Emergency Contact: Relationship: Mobile: Address: Health/ Medical/ Allergy issue(s): * All fields above are required. # The accompanying adult in the playgroup courses, if applicable. Course ☐ Crawlers (6 – 12 Mths) Preferred Days ^ ☐ Mon ☐ Tue ☐ Wed ☐ Thu Time Sessions ^ ☐ Morning No. of Lessons + ☐ 10 ☐ Walkers (12 – 18 Mths) ☐ Fri ☐ Sat ☐ Flexible ☐ Afternoon ☐ 20 ☐ Talkers (18 – 24 Mths) ☐ Flexible ☐ Thinkers (24 – 36 Mths) ☐ Toddlers Phonics (3 – 4 Yrs) ☐ Mon ☐ Tue ☐ Wed ☐ Thu ☐ Morning ☐ 16 ☐ Phonics (5 – 6 Yrs) ☐ Fri ☐ Sat ☐ Flexible ☐ Afternoon ☐ 20 ☐ Flexible TOTAL (HK$) ^ Your choices indicate your preference which we will try our best to accommodate; however, we are unable to guarantee till our confirmation. + Please refer to course descriptions for duration of each lesson. I have read and agreed to the terms and conditions printed at the back of the page. Parent’s Name: ___________________ Parent’s Signature: __________________ Date: ______________________ Handled by: _____________________ Payment: ☐ Cash ☐ Bank Transfer ☐ Cheque www.WMI-Education.com www.facebook.com/wmi.education