Name of student:___________________Family name First name Middle Name.I wish to stay on the folliwing dates:_________ Month/Day/Year to_______________ Month/Day/YearDo you smoke? Do you drink alcoholic beverages? Do you have allergies or other conditions?
參考答案:学生姓名_________[姓，名，教名（外国学生有这个）]
我希望在_______（月，日，年）至_______（月，日，年）留下
你吸烟吗？你喝酒精饮料吗？你有疾病吗？
