~ * ~ 同乡会联合会-福建“寻根夏令营”-报名 ~ * ~
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以下为小孩(或领队)的基本信息 ( Information of the young Participant)
First Name Last Name *
中文姓名(Chinese Name) *
Phone number *
Email *
生日(Birth Date) *
MM
/
DD
/
YYYY
年龄(Age) *
性别(Sex) *
护照号 (Passport #) *
Start with us for a US passport, and cn for a Chinese passport, eg. us1234567, cn1234567
护照颁发国 (Nation which issued the passport) *
us for USA, cn for China
结束时,是否直接返回美国 (will return USA imediately after the camp?) *
身高height *
cm as unit, eg. 175
衣码(中国的号要小一到两个单位)clothes size *
鞋码shoe size *
饮食禁忌 (Any food restriction) *
过敏史(allergies) *
重大病史 (Major medical conditions) *
美国住址 (Address in USA) *
所在州 (in which state of USA) *
请填入两个字母的缩写
以下为家长在美国的联系信息 (Information of the parents) 报名领队的填自己的信息
报名领队的可以继续填自己的信息
父母姓名1(parent name) *
电话1(phone #) *
E-mail1 *
籍贯1 (Hometown in China) *
住址1 (Address) *
父或母 (father or mother) *
护照号p (Passport #)
如果报名参加夏令营 (if you register to go)
是否报名当领队参加夏令营-(Register to be a chaperone) *
父母姓名2(Parent name) *
电话2 (Phone #) *
E-mail2 *
籍贯2 (Hometown in China) *
住址2 (Address)
以下为在中国的联系信息 (Contact Information in China)
国内联系人姓名 (Contact Name in China) *
与小孩关系 (Relationship with child) *
国内电话 (Phone # in China) *
国内住址 (Address in China) *
结束时,如小孩不直接回美,是否前来住处接走?是否与小孩相识?(When camp is closed, if someone will come to pick up the child and if they know each other? etc.) *
免责声明:(statement of consent and release of liability) *
By checking here, I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. I am the legal parent or guardian of the child. I fully understands the risks involved in the activities, and fully, voluntarily and freely assume any and all risks. I understand that participant is fully responsible for all his/her activity and any consequence may occur. I acknowledge and agree that POC assume no liability for any accident, illness, injury, loss or damage to personal property or any other consequences arising or resulting directly or indirectly from the participation in the event. I also understand that it is sole parent's responsibility to arrange means to send child to report to camp and pick up the child when the camp is closed.
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