QAIS Emergency Contact Information 2016 2017 Staff Member's Name 职工姓名* First 名字 Middle 中间名 Last 姓氏 Title at QAIS Department(s)You can choose more than one Montessori Toddler & Early Childhood IB Primary Years Program IB Middle Years Program IB Diploma Program Support Administration Finance Address in Qingdao 在青岛的住址* Street Address 街道 Postal Code 邮编 Cell Phone Number (In China) 电话号码（中国）* Email Address 邮箱地址* Date of Birth 出生日期* MM slash DD slash YYYY Nationality 国籍*Please pick your nationalityAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwePreferred Language 倾向使用的语言* English 英文 Chinese 中文 Passport No 护照号码* Upload a copy of your passport 上传您护照信息页照片Max. file size: 80 MB.Health Insurance Provider 提供医疗保险机构 Health Insurance Member Number 医疗保险号 In the event of an emergency 紧急事件Contact Person in ChinaName 姓名* Phone Number 电话号码* Email 邮箱 Address 地址Relationship 紧急事件联系人与您的关系*Father 父亲Mother 母亲Sibling 兄弟姐妹Other Family Member 其他家庭成员Friend 朋友Colleague 同事Partner/Spouse 爱人Contact Person in Home Country (1)Name 姓名* Phone Number 电话号码* Email 邮箱* Relationship 紧急事件联系人与您的关系*Father 父亲Mother 母亲Sibling 兄弟姐妹Other Family Member 其他家庭成员Friend 朋友Colleague 同事Partner/Spouse 爱人Address 地址Contact Person in Home Country (2)Name 姓名 Phone Number 电话号码 Email 邮箱 Relationship 紧急事件联系人与您的关系Father 父亲Mother 母亲Sibling 兄弟姐妹Other Family Member 其他家庭成员Friend 朋友Colleague 同事Partner/Spouse 爱人Address 地址Please list any allergies or other health advisories in the space below: 请在下方列出任何过敏情况或者其他健康建议 ：Instructions for Repatration of Remains (For foreigners) Forms . Staff Forms |
