Summer Kids Camp 兒童夏季日營
(Burnaby 本拿比)

NOTE 請注意:
1. the enrolment confirmation of the program is based on a first come first serve basis with full payment.
   參加者取錄以繳費先後為準。

*REQUIRED FIELD

Child's Information 參加兒童資料

Name 姓名*

Gender 姓別*
M 男F 女

Age 年齡*

Birthday 出生日期 (M月/D日/Y年)*
---123456789101112 / ---12345678910111213141516171819202122232425262728293031 / ---20072008200920102011201220132014201520162017

Address 地址*

Tel 電話*

Email 電郵*

Name of Family Doctor 家庭醫生姓名 Tel. 電話
Name of Dentist 牙醫姓名 Tel. 電話
Name of Other Specialist 其他專科醫生 Tel. 電話

Please list any medical/health conditions that CCM needs to be aware of
請詳列中信需要知道有關兒童的健康/醫療狀況

Food Allergies 食物敏感*No 沒有Yes 有
Medicine Allergies 藥物敏感*No 沒有Yes 有
Other Allergies 其他敏感*No 沒有Yes 有
Please note that your child might be send home if he/she requires special assistance that was not mentioned on their registration form.
請注意如果你的孩子需要特殊幫助，但沒有在報名表上提及，我們將保留送孩子回家的權利。

Emergency Conatcts 緊急聯絡人 /
Pickup Persons 接送人

Please bring ID when picking up child 請攜帶身份證件接送兒童

1. Name 姓名*

Relationship 關係*

Tel 電話*

1. In consideration of Chinese Christian Mission of Canada (“CCM” and/or “CCM Centre”) accepting the person named hereinafter as a service user/activity participant, I (the parent/guardian) consent to the aforementioned Child's participation in CCM as a service user/activity participant. I hereby release CCM, its directors, officers, servants, employees and agents, from any claims, damages actions or liability arising out of any loss, injury or damage to the Child and of the Child's property during the Child's participation in any CCM services and activities at any location. I hereby give consent to CCM to release the Child's information to the paramedic/emergency services during an emergency situation.
   本人作為孩童之父母／監護人同意前述者（現年未足十六歲之孩童）參加中信中心舉辦的課程、服務或活動。本人並聲明,日後該孩童在中信中心參加任何課程、服務或活動時引致之責任索償、糾紛、財產損失、人身受傷、及物件破壞等等，概與中信中心、其職員及代表人無涉。本人亦同意中信中心在緊急情況時向醫療或健康機構提供該孩童的健康情況資料。
2. I (the parent/guardian) consent that Chinese Christian Mission (CCM) can use the Minor's image and voice in CCM's production of photography, film, video, and audio materials, which will be used for the promotion of CCM and its services. I, understand that these audio/visual materials will be published for selling or presenting in newspapers, films, television commercials, posters, slide presentations or otherwise displayed to the public, as well as for educational, fundraising, information or training purposes – either in whole or in part. I fully understand that I am donating my services and I hereby waive any demands for service fees or payments.
   本人作為孩童之家長／監護人同意中信中心職員、義工、或其代理人在中信中心製作的照片、電影、電子影音使用該童的肖像及聲音來介紹和推廣中信中心、或中信中心服務及社區服務。本人完全明白和同意這些照片、電影、電子影音等資訊將由中信中心以部份或全套租、借或銷售等辦法在報紙、電影、電視廣告、海報、招貼、幻燈或其它的方式向公共展示﹐或用作教育、籌款、信息、或訓練等用途。本人完全明白和同意我這項服務是不收任何費用、報酬或償還的捐贈。
3. I (the parent /guardian) understand that the participant is under the parent's/guardian's care before (extended care: 8:30am; regular 9:30am) and after (extended care: 6:00pm; regular 4:00pm) CCM Kids Camp. Once child has been signed out of camp, it is the responsibility of the parents/guardians to ensure the safety of their child(ren).
   本人作為孩童之父母／監護人清楚及明白中信中心兒童日營開始前（延伸服務：上午8時半；日營：上午9時半）及完畢後（延伸服務：下午6時；日營：下午4時）是有責任看顧參加者。簽名接走孩子後，父母/監護人必需確保孩子的安全。
4. All online engagement sessions will be recorded by Vancouver CCM Canada Leadership for security and protection purposes and will be maintained permanently on a confidential drive. By signing below, you are permitting your child to use the webcam while the session he/she is participating in is being recorded. If parents choose to not opt-in, your child will not be permitted to use the webcam during the session, but will be able to participate using only audio and/or platform chat box, which will still be recorded.
   出於安全和保護目的，溫哥華中信中心領導層將記錄所有在線參與會議，並將其永久加密儲存。通過在下面簽名，您同意允許孩子在記錄正在參加的會話的同時使用網絡攝像頭。如果父母選擇不同意，您的孩子則將無法在會話期間使用網絡攝像頭，但只能使用音頻和/或聊天框平台參與，但仍會被記錄下來。
5. I voluntarily agree and consent to the participation of my/our Child in this supervised online program. While every precaution is taken for the safety and good health of my child, some online activities carry with them the inherent risk of data breaches beyond the risks associated with many of the online programs at Vancouver CCM Canada. I/we understand that I am exposing my Child to inherent risks. I accept all these risks and agree that by allowing my child to participate in these online programs that I will be responsible for any breach or loss which may occur during my child’s participation of these online programs. I/we, named below, agree to indemnify and hold blameless Vancouver CCM Canada, its Personnel, its leaders and Board from and against any loss, damage or breach suffered by the participant as a result of participating in the online programs of Vancouver CCM Canada. This consent and authorization is effective only when participating in programs of Vancouver CCM Canada.
   我自願同意並同意我/我們的孩子參加此受監督的網上互動。雖然儘管為我的孩子的安全和健康采取了所有預防措施，一些網上互動卻伴隨著數據洩露的固有風險，這超出了溫哥華中信的許多網上互動所帶來的風險。我/我們了解我正在使我的孩子承受固有的風險。我接受所有這些風險，並同意通過允許我的孩子參加這些網上互動，我將對我的孩子參加這些網上互動期間可能發生的任何違約或損失負責。本人/我們，如下所述，同意就參加溫哥華中信網上互動而造成的任何損失，損害或違約行為承擔賠償責任，並使溫哥華中信及其人員，領導和董事會免受任何責備。該同意和授權僅在參加溫哥華中信的網上互動時有效。
6. I (the parent /guardian) understand that there is a cost of $5.00 each time a receipt needs to be reprinted / resent through email. If student withdraws for personal reasons 2 weeks before camp start date (first day of camp each week), he/she can refund with 10% as administrative cost which shall not be less than $5.00. If student withdraws 1 week before camp start date (first day of camp each week), he/she can refund with 50% as administrative cost. There is no refund once the camp starts.
   本人作為孩童之父母／監護人清楚及明白收據若需要重印或以電郵方式再發出，均每次收費$5.00。開課兩個星期前，學生因某些原因申請退學，扣除學費10%（以不少於五元）手續費後可獲退款。開課一個星期前申請退學，扣除學費50%手續費後可獲退款。日營開始後不得退款。
7. I (the parent /guardian) have read and ensure that all information on the registration form are correct.
   本人作為孩童之父母／監護人已閱讀並確保報名表上的所有資料均正確無誤。

Name of Parent(s) / Guardian 家長或監護人姓名*