国际青年机器人培训夏令营报名表
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国际青年机器人培训夏令营报名表
感谢您能抽出几分钟时间来填写以下内容，现在我们就马上开始吧！
Q1:1、营期选择（Camp Selection）
第一期（Session 1） 2018.07.01～2018.07.14 (July 1st~July 14th)
第二期（Session 2） 2018.07.15～2018.07.28 (July 15th~July 28th)
第三期（Session 3） 2018.07.29～2018.08.11 (July 29th~August 11th)
Q2:2、制服尺寸（Uniform Size）
S
M
L
XL
Q3:3、申请人姓名（Applicants Name）
选项1
Q4:4、申请人性别（Applicants Sex）
男／M
女／F
Q5:5、申请人出生年月（Applicants Data of birth）
日期
Q6:6、申请人护照号码（Applicants Passport Number）
选项1
Q7:7、申请人就读学校名称（Applicants School Name）
选项1
Q8:8、申请人就读学校地址（Applicants School Address）
省份
城市
区/县
街道
Q9:9、学生是否有过敏症（如对药物、植物、宠物等）、慢性病或正在接受某种治疗？（Does the applicant have any allergies, chronic illness, or medical conditions?）
是／Yes 请详细阐述／Please describe
否／No
Q10:10、学生是否对膳食／住宿有特殊要求？（Does the applicants have any special need on diet or accommodation?）
是／Yes 请详细阐述／Please describe
否／No
Q11:11、紧急联络人信息（Emergency contact person）
姓名（Name）
手机（Cell phone）
与申请人的关系（Relation to Applicant）
Q12:12、监护人信息（父亲）／Fathers Information
姓名（Name）
工作单位（Company）
手机（Cell phone）
微信（WeChat）
邮箱（Email）
Q13:13、监护人信息（母亲）／Mothers Information
姓名（Name）
工作单位（Company）
手机（Cell phone）
微信（WeChat）
邮箱（Email）
Q14:14、监护人家庭住址（Guardians Home Address）
省份
城市
区/县
街道
Q15:15、学费（Tuition Amount）：
美国本地学生（American Students）： USD 3,644
国际生（International Students）：RMB 29,688
Q16:16、学费缴费方式（Payments）
现金／Cash
支票／Check
电汇／Wire Transfer
Q17:PIA免责声明（PIA Tech League Waiver Liability）
需要家长签字（Requires Patent's Signature）
You have our permission, in the event of an emergency and in case we are unavailable, to authorize any physician, nurse practitioner or medical personnel to examine, interview, test and if necessary, treat my child as the may deem advisable.
父母／合法监护人姓名（Parent/Legal guardian name）
父母／合法监护人签字（Parent/Legal guardian Signature）
学生过敏（Student Allergies）
学生医疗问题（Student Medical Problems）
医生（Doctor）
电话（Doctor's Phone Number）
保险公司（Insurance carrier）
保单号（Policy number）
谁对学生的财务经济负责？（who is financially responsible for the student?）
在此我授权PIA Tech League LLC的公司员工，出于教育和推广的目的，对学生进行拍照和摄像（I hereby give permission to PIA Tech League LLC., to photograph and/or videotape the student for educational or promotional purposes.）
Parent Statement: I hereby state that my child is in good mental and physical health condition to participate in the activities provided by PIA Tech League LLC., including but not limited to all aspect of training, playing, outdoor activities such as basketball, soccer and or competition. I am fully aware that any activity involving motion, height or athletic activity creates the possibility of serious injury. I hereby release PIA Tech League LLC., its employee and its staff from liability to above named athlete, of the person claiming through him/her, arising from injury to the person or property of the above named athlete occurring in the premises of PIA Tech League LLC., including any event sponsored or sanctioned by PIA Tech League LLC., and or travel to and from such activities.
I understand that PIA Tech League LLC., has the right to deny admittance to any student not meeting the standards of the program as it sees fit. I also agree not to hold these parties responsible in the event that my son/daughter/child engages in inappropriate conduct (including, but not limited to disruptive or volatile behavior in or out of camp. etc.) or becomes involved in any activity or with any persons not associated with PIA Tech League LLC., or its scheduled program and that PIA Tech League LLC., has the right to send him/her home for inappropriate conduct. I further attest that the information contained in this application is correct to the best of my knowledge. In addition, I have agreed to the policy and fee statement and agree to comply.
家长或监护人签名（Parents/Guardian Signature）
签名日期（Date）
Contact Information: For more information, contact Email: info@piatechleague.org Jenny 老师， 402-770-0552 Barry 老师， 347-567-9328
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