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1、10136 Colebrook Ave. Potomac, MD 20854 USA Phone: 1-301-838-0687, 1-888-850-8081; Fax: 1-240-396-5388; Email: infoacesus.org; Website: www.acesus.org Summer/Winter Camps Student Application（美国游学申请表,请用英文填写 Please fill the form in English）I am applying for: (我愿意申请) Jan 200_ July 200_ Days _ DaysACES w
2、elcomes participants and hosts of every race, nationality and religion. 美国文化交流协会欢迎各种族、国家和宗教的学生和寄宿家庭！Family： (姓) Name:First： (名) Name: American Name: 美国名字 （可选择）Date of Birth: (生日) _/_/_(mm 月) (dd 日) (yyyy 年)Age: 年龄Gender: 性别School Name: 学校名:Grade: 年级:Photo (护照照片护照照片)Please Smile！ 微笑！微笑！Fathers Full N
3、ame: 父亲姓名:Mothers Full Name: 母亲姓名:Occupation (职业):Occupation (职业):Siblings 1 （兄弟姐妹）Name 姓名Gender 性别Age 年龄Siblings 2 （兄弟姐妹）Name 姓名Gender 性别Age 年龄Character/个性特征：个性特征：Personality (个性)： Outgoing 开朗 Quiet 安静 Social 爱交际 Not very social 不太爱交际 Adapting new environment easily 适应新环境快 Hard to adapt new environ
4、ment 适应不太快Do you like young kids? 你喜欢小孩吗？Hobbies and interests (习惯和爱好) Sports 体育类： Music 音乐类： Other 其他： Favorite Food：喜欢的食物：Allergic to anything? 对何物过敏？I, parents/guardian of _(student name) authorize ACES and host family to sign for proper medical treatment under the situation of emergency, with pr
5、esent of certified physician or in physicians office and/or hospital. (如有需要, 学生家长批准 ACES 和寄宿家庭在有医生在场或在医生诊所或在医院, 代表学生签字处理紧急医疗情况). I authorize my child to participate the program organized by the home country agent and its foreign partner ACES to arrange this homestay camp program. I agree to hold har
6、mless toward home country agent and ACES from all injuries and/or damages incurred negligence and/or intentional acts by any third party. （我同意我的孩子参加该国内代理和其海外合作机构 ACES 组织的寄宿 家庭体验营。任何第三方对我孩子有意或者无意识造成的伤害，我们不追究我们代里的责任。）_ _ _ _Student Signature Parents Name Parent Signature Date学生签字 家长姓名 家长签字 日期ACES ID:
7、10136 Colebrook Ave. Potomac, MD 20854 USA Phone: 1-301-838-0687, 1-888-850-8081; Fax: 1-240-396-5388; Email: infoacesus.org; Website: www.acesus.org Student PhotosComment _Comment: _Please provide two photos with your family and friends. (请提供俩张照片，与家人合照) You should dress properly and reflect good ma
8、nner. （衣着行为应该得体）10136 Colebrook Ave. Potomac, MD 20854 USA Phone: 1-301-838-0687, 1-888-850-8081; Fax: 1-240-396-5388; Email: infoacesus.org; Website: www.acesus.org Students Letter to Host Family10136 Colebrook Ave. Potomac, MD 20854 USA Phone: 1-301-838-0687, 1-888-850-8081; Fax: 1-240-396-5388; E
9、mail: infoacesus.org; Website: www.acesus.org This page is for students personal contact information. Before perspective host family decide to accept the student and necessary background check been done, ACES will not disclose below information. 以下信息是申请材料中的不公开部分，在寄宿家庭决定接受你的孩子以前，我们不把这些信息提供给寄宿家庭。 请填写工
10、整，以方便紧急联系使用。Name:(姓名) Program: (参加项目)Home Address: (家庭住址):City (城市):Province (省):Country (国家):Phone: 电话:Email: 电邮地址:QQ、 MSN 或其它 IM 地址：Father/Guardian 父亲/监护人Mother/Guardian 母亲/监护人Name (姓名):Name (姓名):Employer (工作单位):Employer (工作单位):Phone (电话):Phone (电话):Cell Phone (手机):Cell Phone (手机):Father Email (电邮):Email (电邮):Please provide information from parents about the student for matching host families. (父母对孩子的评价, 以便 ACES 安置家庭时参考使用。)
