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CCICTV 2017-2018 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 09/2017 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
please indicate the items that your child have allergy on. Type "none" if no allergies.
Your answer
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:麥美玲 Ivy Mak
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. Type "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。 如果孩子只说中文也请写明。沒有的話請寫“none”
Your answer
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 church promotion, graduation ceremony, father's day, mother's day or other holidays etc. Select yes to consent to the participation in taking of photographs or videos of the students registered above and give CCICTV permission to use, edit and reuse the said products for non-profit purposes. Select no to exclude your child(ren) from all photos/videos.
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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