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输入信息后点击TAB键，您将自动被被带到下一栏中 Press TAB and jump from one field to the next 基础信息 GENERAL INFOMATION 重要提示：儿童姓名及家长姓名必须与证件所示一致 IMPORTANT: Formal Name of Child and Parents MUST MATCH Passport or National 填表日期（年/月/日） Today’s Date (YY/MM/DD): 填表人/Person Completing Form: 与儿童关系/ Relationship to Child: 儿童姓名/Child’s Name : 性别/Gender: 女/Female 男/ Male 儿童昵称/Name child prefers to be called: 民族/Race/Ethnicity 出生年月（年/月/日）/Date of birth (YY/MM/DD): 年纪/Age: 出生地/Place of Birth: 儿童国籍/Child’s Nationality: 儿童证件号/Child’s Passport/Identification #: 现居住城市/Current City: 何时搬来此地（年/月/日）/Date Moved to Current City (YY/MM/DD): 完整家庭地址/Full home address: 家庭电话/Home phone number: 母亲姓名Mother’s Name: 父亲姓名Father’s Name: 母亲手机号Mother’s mobile number: 父亲手机号Father’s mobile number: 母亲邮件Mother’s e-mail address: 邮件Father’s email address: Mother’s Employer: 父亲工作单位Father’s Employer: 母亲职业Mother’s Occupation: 父亲职业Father’s Occupation: 主要联系人Primary contact person: 母亲Mother 父亲Father 其他，若选择，请提供姓名，联系方式，与儿童的关系 Other; If Checked, please provide name, relationship to child, phone number and email: 兄弟姐妹的姓名及年龄Names and ages of siblings: 就读学校Name of School: 在家使用语言Language(s) spoken at home: 年级，班级Grade/Year Level and Class: 儿童主导语言Child’s dominant language: 在校使用语言Language(s) spoken at school: 您对儿童的健康，发育及行为方面的担忧在于？What are your main concerns about your child’s health, development and/or behavior? 为什么你决定在此时联系我们？Why did you decide to approach LIH Olivia’s Place at this time? 谁介绍儿童来此？Who has referred the child? 我们可否联系介绍人以获取额外信息/说明？May we contact the referrer for additional information or clarification? 是Yes 否No (若是，请提供介绍人/机构名称及联系方式) (If yes, please provide a specific name, organization if appropriate, and contact information) 若儿童是被介绍来此的，您是否同意介绍人的观点？ If your child has been referred, do you agree with the referral? 是Yes 否No 评论Comments: 儿童强项是什么？您欣赏儿童的哪些特质？请提供详细描述What are your child’s strengths? What qualities about your child do you