Please indicate your child's grade as of 08/2019.请输入您孩子2019-2020学年的年級

Child's First Name 孩子的名

Child's Last Name 孩子的姓

please enter your child's Chinese name／nickname if applicable 請輸入孩子的中文名字／暱稱

Check None if no allergies. Check Other and Specify the items that your child have allergy.

Please enter your Child's Birthday  孩子生日

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。

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

Please enter mom's cell phone number in this format: 請輸入母親的手機號碼：(###)###-####

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

Please enter dad's cell phone number in this format: 請輸入父親的手機號碼：(###)###-####

Please enter Child's home phone number in this format: 請輸入孩子的家庭電話號碼：(###)###-####

Please enter mom's email address: 請輸入母親的電子郵箱

Please enter dad's email address: 請輸入父親的電子郵箱

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

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。

Please indicate if mom is Christian or not: 母親是基督徒嗎？

Please indicate if mom would like to volunteer in children's department: 母親願意到兒童組幫忙嗎？

Please indicate if dad is Christian or not: 父親是基督徒嗎？

Please indicate if dad would like to volunteer in children's department: 父親願意到兒童組幫忙嗎？

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

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

紧急联系人（除父母外）Enter emergency contacts (other than parents) name, phone number and relationship.

(除父母外)授权接送人 Please put down authorized pickup personnels' name, cell phone number and relationship.

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.

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.  

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.