Application Form-Playgroup - Mount Kelly Hong Kong

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For Office Use Only:
Application No.: ___________________
Date Received: ___________________
Admissions Office
2/F, Austin Tower Phase Two, 152 Austin Road, Tsim Sha Tsui,, Hong Kong
TEL: +852 2110 1978 / Email:
.hk
PRE-PREPARTORY SCHOOL
PLAYGROUP APPLICATION FORM
Please submit the application by POST or by EMAIL together with the below required documents to our Admissions Office.
Application Checklist
Proof of address (recent utility bill or bank statement)
2 passport-sized photos of the applicant
Proof of a $500 non-refundable administrative fee payment
by i) Send a cheque together with the application (payable
Completed application form
to “MOUNT KELLY INTERNATIONAL LIMITED”) or ii) Send
Copy of applicant’s birth certificate
a receipt/payment record of Bank Transfer payable to
Mount Kelly International Limited (Bank of China A/C No:
Copy of parent’s HKID card or passport page
012-928-0-005454-8) SWIFT CODE: BKCHHKHH,
Completed & signed Medical & Immunisation Record
together with the application
Applicant’s Details
*Family Name
*First
Chinese Name
(Surname)
Name
(if any)
*Applicant’s name above has to be identical to the birth certificate
Gender
#
Female / Male
Current Age
Months/years old
Other Nationality
Date of Birth
Country of Birth
Nationality
/
/
(if any)
DD
MM
YYYY
Home Address
Language Spoken at home: *
Cantonese
English
Putonghua
Others ______________________________ (please specify)
One adult must accompany and participate in the playgroup, please indicate below who will be accompanying your child:
*
Father
Mother
Others _______________________________
#Circle as appropriate / * tick as appropriate
Parents / Guardian Details
Father / Guardian 1 Details
Father/Guardian’s Family Name
First Name
#
Hong Kong permanent resident?
YES / NO
HKID / Passport no.
Marital Status
Father/Guardian’s First language
Second Language(s) (if any)
*Email Address
Mobile Phone
Residential Address (if different)
Mother / Guardian 2 Details
Mother/Guardian’s Family Name
First Name
Hong Kong Permanent Resident?
#
YES / NO
HKID / Passport no.
Marital Status
Mother/Guardian’s First language
Second Language(s) (if any)
*Email address
Mobile Phone
Residential Address (if different)
Emergency Contact / Allergies
Name
Mobile
Relationship
Any
Phone
with Applicant
Allergies?

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