Registration Form

Last Name (姓)

First Name (名):

Date of Birth (出生日期) – Date (日)

Month (月)

Year (年)

Gender (性别)(required)

Male

Female

Street Address (地址)

City (城市)

Postal Code (邮政编码)

Email (电子邮件)

Phone Number (电话号码)

New or Returning Student? (新 / 复读生)(required)

New

Returning

Please choose desired learning level (may be adjusted upon admission)（请选择班级）(required)

Level 1 (No English) 一级 Learn English words and simple phrases 简单词语

Level 2 (Beginner) 二级 Combine words learned in level 1 into short sentences 形式造句

Level 3 (Intermediate) 三级 Basic grammar and longer sentences, simple reading and comprehension 语法，阅读

Level 4 (Intermediate/Advanced) 三级/ 四级 A continuation of Level 3, more complex language and readings

Level 5 (Advanced) 四级 Conversation, comprehension and reading from newspapers, magazines, etc.

Emergency Contact – Name (紧急情况联系人姓名)

Emergency Contact – Phone Number (紧急情况联系人电话号码)

Code of Conduct(required)

By selecting this box, you have read and agree to the student code of conduct and rules of attendance at the Agincourt Adult ESL Learning Centre (若你已阅读并同意本校的校规和出勤率相关条款，请按钮)

Code of conduct can be viewed here （本校的校规和出勤率相关条款）

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