课后服务申请书怎么写

【模板一：详细版家长申请】

课后服务申请书

申请日期： __年__月____日

一、 学生基本信息 (Student Information)

• 学生姓名 (Student’s Full Name): _______
• 性别 (Gender): ______ (男 Male / 女 Female)
• 出生日期 (Date of Birth): __年_月_日 (YYYY-MM-DD)
• 身份证号/学籍号 (ID Card No./Student ID No.): _______
• 就读年级 (Current Grade): __年级 (Grade ____)
• 就读班级 (Current Class): __班 (Class ____)
• 家庭住址 (Home Address): _______
• 健康状况 (Health Status):
  • [ ] 健康 (Healthy)
  • [ ] 一般 (Fair)
  • [ ] 有特殊健康状况 (With Special Health Conditions) – 如选择此项，请在下方详细说明 (If selected, please specify below):

    _________

    _________

• 过敏史 (Allergies):
  • [ ] 无 (None)
  • [ ] 有 (Yes) – 如选择此项，请详细说明过敏源及反应 (If selected, please specify allergens and reactions):
    • 食物过敏 (Food Allergies): ___________
    • 药物过敏 (Drug Allergies): ______
    • 其他过敏 (Other Allergies): ___________
• 是否需要特殊照顾 (Need for Special Care):
  • [ ] 否 (No)
  • [ ] 是 (Yes) – 如选择此项，请详细说明需要的照顾类型及注意事项 (If selected, please specify the type of care needed and precautions):

    _________

    _________

二、 家长/监护人信息 (Parent/Guardian Information)

• 家长/监护人一姓名 (Parent/Guardian 1 Name): _______
  • 与学生关系 (Relationship to Student): __ (e.g., 父亲 Father, 母亲 Mother, 其他 Other: ___)
  • 联系电话 (Contact Phone – Mobile): _______
  • 备用联系电话 (Contact Phone – Alternative): _______
  • 电子邮箱 (Email Address): _______
  • 工作单位 (Workplace): _______
  • 工作单位电话 (Work Phone): _______
• 家长/监护人二姓名 (Parent/Guardian 2 Name): _______ (如适用 If applicable)
  • 与学生关系 (Relationship to Student): __ (e.g., 父亲 Father, 母亲 Mother, 其他 Other: ___)
  • 联系电话 (Contact Phone – Mobile): _______
  • 工作单位 (Workplace): _______
  • 工作单位电话 (Work Phone): _______

三、 紧急联系人信息 (Emergency Contact Information – 非家长/监护人 Not Parent/Guardian)

• 姓名 (Name): _______
• 与学生关系 (Relationship to Student): _______
• 联系电话 (Contact Phone – Mobile): _______
• 备用联系电话 (Contact Phone – Alternative): _______

四、 申请课后服务的具体原因 (Specific Reasons for Applying for After-School Services)

• [请详细说明您为孩子申请课后服务的具体原因，可以多选或补充说明。 Please explain in detail the specific reasons for applying for after-school services for your child. You may select multiple options or add explanations.]
  • [ ] 家长工作时间与学生放学时间冲突，无法按时接送。(Parent’s work schedule conflicts with school dismissal time, unable to pick up the child on time.)
  • [ ] 双职工家庭，下班时间较晚，孩子独自在家存在安全隐患。(Dual-income family, parents get off work late, posing safety risks for the child staying home alone.)
  • [ ] 希望孩子在课后得到专业的作业辅导和学业帮助。(Hope the child can receive professional homework tutoring and academic assistance after school.)
  • [ ] 希望孩子利用课后时间参加兴趣培养或素质拓展活动。(Hope the child can utilize after-school time to participate in interest cultivation or quality development activities.)
  • [ ] 孩子在家缺乏良好的学习环境或学习习惯，希望在学校环境中完成作业。(Child lacks a good learning environment or study habits at home, hoping to complete homework in the school setting.)
  • [ ] 减轻家庭在课后辅导方面的负担。(Alleviate the family’s burden regarding after-school tutoring.)
  • [ ] 方便孩子与其他同学进行交流互动，培养社交能力。(Facilitate interaction and communication between the child and classmates, fostering social skills.)
  • [ ] 其他原因 (Other reasons) – 请详细说明 (Please specify):

    _________

    _________

    ___________

五、 期望参加的课后服务内容 (Desired After-School Service Content)

• [请根据学校提供的服务项目进行选择，可多选，并可按意愿排序。 Please select from the service items offered by the school. Multiple selections are allowed, and you may rank them by preference if applicable.]
  • [ ] 基本托管服务 (Basic Care Service):
    • [ ] 完成家庭作业辅导 (Homework Completion Guidance)
    • [ ] 课外阅读指导 (Extracurricular Reading Guidance)
    • [ ] 自由活动/休息 (Free Activity / Rest)
  • [ ] 兴趣类/素质拓展类服务 (Interest-Based / Quality Development Services): (请勾选感兴趣的项目 Please check interested items)
    • [ ] 体育类 (Sports): ______ (e.g., 篮球 Basketball, 足球 Soccer, 乒乓球 Table Tennis, 羽毛球 Badminton, 武术 Martial Arts)
    • [ ] 艺术类 (Arts): ______ (e.g., 绘画 Painting, 书法 Calligraphy, 手工 Crafts, 舞蹈 Dance, 合唱 Choir)
    • [ ] 音乐类 (Music): __ (e.g., 器乐 Instrument: ____, 声乐 Vocal Music)
    • [ ] 科技类 (Science & Technology): ______ (e.g., 编程 Coding, 机器人 Robotics, 科学实验 Science Experiments)
    • [ ] 语言类 (Language): ______ (e.g., 英语角 English Corner, 小主持人 Little Host)
    • [ ] 棋类 (Board Games): ______ (e.g., 象棋 Chinese Chess, 围棋 Go, 国际象棋 Chess)
    • [ ] 其他 (Others): _______
  • 对服务内容的具体期望或建议 (Specific Expectations or Suggestions for Service Content):

    _________

    _________

六、 参加课后服务的时段选择 (Desired Time Slots for After-School Services)

• [请根据学校安排勾选希望参加的时段 Please check the desired time slots according to the school’s schedule]
  • [ ] 周一 (Monday)
  • [ ] 周二 (Tuesday)
  • [ ] 周三 (Wednesday)
  • [ ] 周四 (Thursday)
  • [ ] 周五 (Friday)
  • [ ] 全周 (Entire Week – Mon to Fri)
• 是否有特殊时间安排需求 (Any Special Scheduling Needs): (例如：某天需要提前离开 e.g., need to leave early on a certain day)

  ___________

七、 课后服务结束后的接送安排 (Pick-up Arrangements After Service)

• 接送方式 (Pick-up Method):
  • [ ] 家长/监护人亲自接送 (Parent/Guardian picks up in person)
  • [ ] 委托他人接送 (Entrust others to pick up) – 如选择此项，请在下方提供被委托人信息 (If selected, please provide information of the authorized person(s) below)
  • [ ] 学生自行回家 (Student goes home by themselves) – (请确认符合学校相关规定及学生年龄适合 Please ensure compliance with relevant school regulations and suitability for the student’s age)
• 固定接送人信息 (Regular Pick-up Person(s) Information – 若非家长本人 If not the parent/guardian):
  • 姓名 (Name): __ 关系 (Relationship): __ 联系电话 (Phone): ___
  • 姓名 (Name): __ 关系 (Relationship): __ 联系电话 (Phone): ___
  • (如有需要可添加 If needed, add more)
• 预计接送时间 (Estimated Pick-up Time): ___ (请在学校规定的接送时间内 Please adhere to the school’s designated pick-up time window)

八、 家长/监护人承诺与确认 (Parent/Guardian Commitment and Confirmation)

本人已仔细阅读并理解学校关于课后服务的相关规定、管理办法及收费标准（如适用）。本人承诺：

(I have carefully read and understood the school’s relevant regulations, management measures, and fee standards (if applicable) regarding after-school services. I promise to:)

1. 遵守学校课后服务的各项规章制度，配合学校和老师的管理。(Abide by all rules and regulations of the school’s after-school services, and cooperate with the management of the school and teachers.)
2. 按时缴纳课后服务相关费用（如适用）。(Pay relevant after-school service fees on time (if applicable).)
3. 保证提供的学生信息、家长信息、紧急联系人信息真实有效，如有变更及时通知学校。(Ensure that the provided student information, parent information, and emergency contact information are true and valid, and notify the school promptly of any changes.)
4. 教育孩子遵守课后服务期间的纪律要求，注意安全，爱护公物。(Educate the child to observe disciplinary requirements during the after-school service period, pay attention to safety, and take care of public property.)
5. 按时、按规定方式接送孩子，确保孩子离校安全。如委托他人接送，已明确告知被委托人相关事宜并确保其可靠。(Pick up the child on time and according to the prescribed method to ensure the child’s safety after leaving school. If entrusting others for pick-up, I have clearly informed the authorized person of relevant matters and ensured their reliability.)
6. 理解并同意，在紧急情况下（如突发疾病、意外伤害等），学校有权采取必要的急救措施或送往就近医院救治，并会尽快通知家长/监护人。(Understand and agree that in case of emergency (such as sudden illness, accidental injury, etc.), the school has the right to take necessary first-aid measures or send the child to a nearby hospital for treatment, and will notify the parent/guardian as soon as possible.)
7. 同意学校在课后服务活动中为记录和宣传目的拍摄包含孩子肖像的照片或视频，并可能在校内或官方渠道合理使用（如不希望孩子肖像被使用，请在此处注明：[ ] 不同意 Not Agree）。(Consent to the school taking photos or videos containing the child’s image during after-school service activities for recording and promotional purposes, which may be reasonably used within the school or through official channels (If you do not wish your child’s image to be used, please indicate here: [ ] Do not agree).)
8. 确认已知晓课后服务的性质（通常为看护和基本辅导，非强制性学科拔高或强化训练），并对此有合理预期。(Confirm understanding of the nature of after-school services (usually care and basic guidance, not mandatory advanced subject tutoring or intensive training) and hold reasonable expectations.)

申请人 (家长/监护人) 签名 (Applicant (Parent/Guardian) Signature): _______

联系电话 (Contact Phone): _______

日期 (Date): __年_月_日 (YYYY-MM-DD)

【模板二：简化版校内申请】

学生课后服务申请表

申请学年/学期 (Academic Year/Semester): ___

学生信息 (Student Information)

家长/监护人信息 (Parent/Guardian Information)

申请原因简述 (Brief Reason for Application) – 请勾选主要原因 (Please check the main reason(s))

• [ ] 家长工作原因无法按时接管 (Unable to supervise due to parents’ work)
• [ ] 需要作业辅导看护 (Need homework supervision and care)
• [ ] 参加兴趣拓展活动 (Participate in enrichment activities)
• [ ] 其他 (Other): _________

申请参加的服务项目及时段 (Requested Service Items and Time Slots)

• 服务类型 (Service Type):
  • [ ] 课后作业看护 (After-school homework supervision)
  • [ ] 学校组织的兴趣社团/活动 (School-organized interest clubs/activities) – 请注明名称 (Please specify name): _______
• 参加时间 (Participation Days):
  • [ ] 周一 (Mon)
  • [ ] 周二 (Tue)
  • [ ] 周三 (Wed)
  • [ ] 周四 (Thu)
  • [ ] 周五 (Fri)
  • [ ] 全周 (Full Week)

健康状况及特殊需求 (Health Condition and Special Needs)

• 有无过敏史或特殊健康问题需要注意？(Any allergies or special health issues to note?)
  • [ ] 无 (None)
  • [ ] 有 (Yes) – 请简述 (Please briefly describe): _______
• 有无其他特殊行为或学习习惯需要老师关注？(Any other special behaviors or learning habits requiring teacher attention?)
  • [ ] 无 (None)
  • [ ] 有 (Yes) – 请简述 (Please briefly describe): _______

课后离校方式 (Departure Method After Service)

• [ ] 家长接回 (Parent pick-up)
• [ ] 指定人员接回 (Designated person pick-up) – 姓名 (Name): __ 电话 (Phone): __
• [ ] 自行离校 (Student leaves independently) (需符合学校规定 The student must meet school requirements)

家长确认与承诺 (Parent Confirmation and Commitment)

本人确认以上信息属实，已阅读并同意遵守学校课后服务管理规定。本人承诺履行家长责任，配合学校工作，确保学生安全。

(I confirm that the above information is true. I have read and agree to abide by the school’s after-school service management regulations. I commit to fulfilling parental responsibilities, cooperating with the school, and ensuring the student’s safety.)

家长/监护人签名 (Parent/Guardian Signature): ________

日期 (Date): ___

学校审核意见 (School Review Opinion – 由学校填写 For School Use Only)

• [ ] 同意接收 (Approved)
• [ ] 暂缓/不接收 (Deferred / Not Approved) – 原因 (Reason): _______
• 负责人签字 (Signature of Person in Charge): ________
• 日期 (Date): ___

【模板三：侧重兴趣/特长发展申请】

学生课后兴趣拓展服务申请书

致 (To): [学校名称或相关部门名称 Name of School or Relevant Department]

学生信息 (Student Details)

• 姓名 (Name): _______
• 班级 (Class): __年级 _班 (Grade , Class ___)
• 学号 (Student No.): _______
• 联系电话 (Student Contact Phone, if applicable): _______

家长/监护人信息 (Parent/Guardian Details)

• 姓名 (Name): _______
• 与学生关系 (Relationship): _______
• 主要联系电话 (Primary Phone): _______
• 电子邮箱 (Email): _______

申请参加的兴趣拓展项目 (Interest Development Program Applied For)

• 项目名称 (Program Name): _______

  (例如：机器人编程俱乐部、校级篮球队、油画兴趣班、戏剧社等)

  (e.g., Robotics Programming Club, School Basketball Team, Oil Painting Workshop, Drama Club, etc.)

• 选择此项目的理由 (Reason for Choosing This Program):
  • [请详细阐述孩子对该项目的兴趣来源、已有基础（如有）、希望通过该项目获得哪些方面的提升或体验。 Please elaborate on the source of the child’s interest in this program, any existing foundation (if any), and what aspects of improvement or experience they hope to gain from this program.]

  ---

  ---

  ---

  ---

• 孩子在该领域的过往经历或作品（可选填 Optional – 可附页 or attach separate sheet）:

  (例如：参加过的相关比赛、获得的证书、相关作品照片链接或描述等)

  (e.g., participation in related competitions, certificates obtained, links or descriptions of related works, etc.)

  _________

  _________

家长的期望与支持 (Parent’s Expectations and Support)

• 您希望孩子通过参加此项目达到什么目标？(What goals do you hope your child achieves by participating in this program?)

  _________

  _________

• 您将如何支持孩子参与此项目？(How will you support your child’s participation in this program?)

  (例如：保证出勤、准备必要的材料、鼓励与引导等)

  (e.g., ensuring attendance, preparing necessary materials, providing encouragement and guidance, etc.)

  _________

  _________

参加时间与承诺 (Time Commitment and Pledge)

• 是否能保证在项目活动时间内全程参与？(Can you guarantee full participation during the program’s activity times?)
  • [ ] 是 (Yes)
  • [ ] 基本可以，特殊情况会提前请假 (Mostly yes, will request leave in advance for special circumstances)
• 项目活动时间 (Program Schedule): [请根据学校公布的时间填写或确认 Please fill in or confirm according to the schedule announced by the school]

  每周 __ 的 _: 至 :___ (Every [Day of Week] from [Start Time] to [End Time])

• 承诺 (Pledge): 本人及孩子已知晓并愿意遵守该兴趣拓展项目的管理规定、出勤要求及可能产生的材料费用（如有）。孩子将积极参与活动，尊敬师长，团结同学。

  (My child and I are aware of and willing to abide by the management regulations, attendance requirements, and potential material costs (if any) of this interest development program. The child will actively participate in activities, respect teachers and elders, and unite with classmates.)

健康与安全信息 (Health and Safety Information)

• 是否有影响参加此项特定活动的健康问题或过敏史？(Any health issues or allergies affecting participation in this specific activity?)
  • [ ] 无 (None)
  • [ ] 有 (Yes) – 请说明 (Please specify): ___________
• 紧急联系人 (Emergency Contact): 姓名 (Name): __ 电话 (Phone): __

确认与签名 (Confirmation and Signature)

本人确认所填信息真实无误，并同意以上所有条款。

(I confirm that the information provided is true and accurate, and I agree to all the terms above.)

学生签名 (Student Signature) (如适用 If applicable): _______

家长/监护人签名 (Parent/Guardian Signature): _______

申请日期 (Date of Application): __年_月_日 (YYYY-MM-DD)

(以下由学校填写 Below to be filled by the school)

• 审核意见 (Review Comments):
  • [ ] 同意加入 (Approved to join)
  • [ ] 需面试/测试 (Interview/Test required)
  • [ ] 名额已满/条件不符，未通过 (Quota full / Does not meet criteria, Not approved)
• 经办人/指导老师签字 (Signature of Handler/Instructor): ________
• 日期 (Date): ___