普及言語培訓報名  

如想申請早期診斷評估,請先填妥及遞交以下報名表格,本會職員會於收取表格後與你聯絡。

申請人如須申請減費,請先與本會職員聯絡(WhatsApp: 9139-2705)。

早期診斷報名表
Early Diagnosis Enrolment Form

參加者資料

Details of Participant:

現有困難 Presenting Problems:
懷疑發展障礙 Suspected Developmental Problem:

家長 / 監護人資料

Details of Parent / Guardian:

聲明及簽署 Declaration and Signature
 
本人明白以下事項 I understand the following matters:
1. 申請人請細閱服務詳情及要求,本會有權拒絕任何申請,而無須作任何解釋。Applicant should read the service details and requirements carefully. The Association reserves the right to reject any application without any explanation.
2. 申請減費之申請人,須向本會遞交家庭入息證明文件或其他相關資料。詳情請與本會職員聯絡(WhatsApp: 91392705)。Applicants applying for the reduction of assessment fee are required to submit proof of family income or other related documents to our Association. Please contact our staff (WhatsApp: 91392705) for details.
3. 因颱風或其他惡劣天氣而被取消之評估,本會職員將聯絡申請人安排改期事宜。Our staff will contact the applicant to re-schedule the assessment that has been cancelled due to bad weather.
4. 本會保留隨時更改或終止各項條款及細則之權利,而無須另行通知。如有任何爭議,概以本會之最終決定為準。The Assocation reserves the right to amend or terminate the respective terms and conditions without prior notice. In the event of any dispute, the decision of the Association shall be final.
5. 申請人有權查詢及更正所提供的個人資料。Applicant reserves the right to enquire or amend their personal particulars provided to our Association.
如閣下同意上述事項,請在下方填寫你的姓名。If you agree with above-mentioned matters, please type your name below.
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香港中文大學心理學系腦智能研究室

電話: (852) 3943-4166

 

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電話: (852) 9139-2705 (WhatsApp)

電郵: info.protalent@gmail.com

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