Christmas 2018 Registration Form

Christmas 2018 – Enrollment Form

Please complete a separate form for each child. Enrollment will be confirmed via email only when both this enrollment form and full tuition payment have been received. Enrollment is not guaranteed if we do not receive your payment within 5 business days of receiving this form. Payments can be made by crossed check payable to "Baker and Bloom Limited".

For enquiries, please email info@bakerandbloom.com.
Student Information
Student's Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Gender*
Grade (2018-2019)*
School*
Student E-mail (if any)
Student's Contact No. (if any)
Format: 00000000.
Home Address*

Floor, Block, Building, Estate

Street Name

DistrictCity

Attn:Country
Remarks
Has the student attended Baker & Bloom before?*

YesNo
Please select the sessions he/she has attended.

Easter 2018CNY 2018Spring 2018Christmas 2017Fall 2017Summer 2017Easter 2017CNY 2017Spring 2017Fall 2016Summer 2016Spring 2016Easter 2016CNY 2016Christmas 2015Fall 2015Summer 2015Spring 2015Christmas 2014Fall 2014
Parent Information
Parent's Name*

First NameLast Name
Relationship to Student
Parent's Contact No.*
Format: 00000000.
Parent's Email*

Confirmation Email
Is this parent the primary emergency contact?*

YesNo
Emergency Contact Name

First NameLast Name
Relationship to Student
Emergency Contact No.
Format: 00000000.
How did you hear about Baker & Bloom?*

Search Engine (e.g. Google, Yahoo)Facebook or other websiteEvent hosted by Baker & BloomPrint Advertisement (e.g. newspaper, magazine)Friend's RecommendationOther
Full name of person who referred you to Baker & Bloom:*
Course Selection
Select Your Course(s)*
prevnext( X )
Age 4-5 inspirED Reader & Writer: How The Grinch Saved Christmas2,000HKD

Time Slot
Item subtotal:0.00HKD

Age 4-5 Public Speaking800HKD

Time Slot

Age 6-7 inspirED Reader & Writer: The Polar Express4,500HKD

Time Slot
Item subtotal:0.00HKD

Age 6-7 Creative Writing4,500HKD

Time Slot

Age 6-7 Public Speaking4,500HKD

Time Slot
Item subtotal:0.00HKD

Age 8-9 inspirED Reader & Writer: Christmas Around the World4,500HKD

Time Slot
Item subtotal:0.00HKD

Age 8-9 Creative Writing4,500HKD

Time Slot

Age 8-9 Public Speaking4,500HKD

Time Slot
Item subtotal:0.00HKD

Age 8-9 Super Learner1,800HKD

Time Slot

Age 9-11 Super Learner2,700HKD

Time Slot

Age 10-11 Public Speaking4,500HKD

Time Slot

Age 10-11 Super Learner4,500HKD

Time Slot

Age 11-13 Boarding School Essay Workshop5,000HKD

Time Slot
Item subtotal:0.00HKD

Age 12-18 Media Literacy in partnership with The New York Times6,000HKD

Time Slot
Item subtotal:0.00HKD

Age 13-15 Essentials of Essay Writing6,000HKD

Time Slot
Item subtotal:0.00HKD

Age 14-15 IGCSE English3,600HKD

Time Slot

Age 16-18 IBDP English3,600HKD

Time Slot

Age 16-18 College Essay Clinic6,000HKD

Time Slot

Total 0.00HKD
Tuition (HKD)
Payment Method*

Cash (submitted in-person)Crossed check payable to "Baker and Bloom Limited" (mailed or delivered in person to our center)Direct deposit to BEA account no. 015-514-680-12333 (deposit slip emailed to info@bakerandbloom.com)Direct deposit to HSBC account no. 004-848-867388-838 (deposit slip emailed to info@bakerandbloom.com)
Check or Bank Transaction Number
Parent Name
Parent Signature*
Date

DayMonthYear
Should be Empty:

Student Information

Parent Information

Course Selection