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CCICTV 2018-2019 Sunday Children Registration
三谷基督徒會堂
5064 Franklin Dr., Pleasanton, CA 94588
Tel: (925) 467-1580
E-mail: children@ccictv.org


Sunday School: 9:30am-10:45am
Sunday Worship: 11:15am-12:15pm


Matthew 19:14 Jesus said, "Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these."
馬太福音19:14 耶穌說:「讓小孩子到我這裡來,不要禁止他們,因為在天國的正是這樣的人。」
Proverbs 22:6 Start children off on the way they should go, and even when they are old they will not turn from it.
箴言22:6 教養孩童,使他走當行的道,就是到老他也不偏離。

Grade *
Please indicate your child's grade as of 08/2018.请输入您孩子2018-2019学年的年級
First Name *
Child's First Name 孩子的名
Your answer
Last Name *
Child's Last Name 孩子的姓
Your answer
中文姓名
please enter your child's Chinese name/nickname if applicable 請輸入孩子的中文名字/暱稱
Your answer
Allergy *
Check None if no allergies. Check Other and Specify the items that your child have allergy.
Required
Birthday *
Please enter your Child's Birthday 孩子生日
MM
/
DD
/
YYYY
Siblings *
Please enter child's siblings' names. Use comma to separate multiple siblings. Enter "none" if no siblings. 請輸入孩子的兄弟姐妹的名字 . 請輸入“none” 如果沒有兄弟姐妹。
Your answer
Mom *
Please enter child's mother's name. Suggested use both Chinese and English name. 請輸入孩子的母親的姓名。盡量輸入中文和英文名字。 例如:陈燕伦 Elan
Your answer
Mom's Cell *
Please enter mom's cell phone number in this format: 請輸入母親的手機號碼:(###)###-####
Your answer
Dad *
Please enter child's father's name. Suggested use both Chinese and English name. 請輸入孩子的父親的姓名。盡量輸入中文和英文名字。 例如:吳建智 Miles Wu
Your answer
Dad's Cell *
Please enter dad's cell phone number in this format: 請輸入父親的手機號碼:(###)###-####
Your answer
Home # *
Please enter Child's home phone number in this format: 請輸入孩子的家庭電話號碼:(###)###-####
Your answer
Mom's Email *
Please enter mom's email address: 請輸入母親的電子郵箱
Your answer
Dad's Email *
Please enter dad's email address: 請輸入父親的電子郵箱
Your answer
Home Address *
Please enter Child's home address with city name and zip code: 請輸入孩子的家庭住址, 請一定記得輸入城市和郵編:sample address 例如:5460 Franklin Dr., Pleasanton CA 94588
Your answer
Special Needs? *
Please indicate if your child have special needs or needs special care. Talk to our age group coordinators. Check None if no special needs. 請寫下孩子的特別需要或者是否需要特別照顧。 如果孩子英文还需要帮助, 请注明孩子会的语言。
Required
Mom Christian? *
Please indicate if mom is Christian or not: 母親是基督徒嗎?
Mom Volunteer? *
Please indicate if mom would like to volunteer in children's department: 母親願意到兒童組幫忙嗎?
Dad Christian? *
Please indicate if dad is Christian or not: 父親是基督徒嗎?
Dad Volunteer? *
Please indicate if dad would like to volunteer in children's department: 父親願意到兒童組幫忙嗎?
Other Guardian
Please put down guardian's name if child does not live with parents. 孩子如果不是跟父母同住,請輸入監護人姓名
Your answer
Guardian Cell
Please put down guardian's cell # if child does not live with parents. 孩子如果不是跟父母同住,請輸入監護人手機號碼
Your answer
Emergency Contacts *
紧急联系人(除父母外)Enter emergency contacts (other than parents) name, phone number and relationship.
Your answer
Authorized PickUp *
(除父母外)授权接送人 Please put down authorized pickup personnels' name, cell phone number and relationship.
Your answer
Photography/Video Consent *
We occasionally take photos/videos. We only use these products for non-profit purposes, such as classroom crafts, church promotion, graduation ceremony, father's day, mother's day or other holidays etc. By signing up my child for Sunday School/Sunday Worship or other activities in this church, I understand that my child will participate in taking of photographs or videos and give CCICTV permission to use, edit and reuse the said products for classroom and other non-profit purposes.
Required
Terms and Conditions *
1)I understand that my child/children may participate in physical activities during game time. As with any physical activity, there is a risk of injury. I fully accept this risk and hold harmless from any legal liability, CCIC-TV and any personnels involved in the programs. 2) In the event of an emergency that requires medical treatment for the above named child/children, I understand that every effort will be made to contact me or my emergency contact. However, if I/we cannot be reached, I give my permission to the teachers/volunteers to secure the services of a licensed physician to provide the care necessary for my child’s well being. I assume responsibility for all costs connected to any accident or treatment of my child.
Required
Signature *
簽名: I understand that by printing/typing my name below, I acknowledge that I signed this form and agree to all terms and conditions.
Your answer
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