Protect Chinatown - Chaperone Request            
保护唐人街 - 申请同伴

欢迎来到保护唐人街!
最近，许多亚洲人在街上遭到袭击。
[保护唐人街] 的任务是在您外出时,为您提供合作伙伴。
志愿者的工作要求是与您同行以在一定时期内执行日常任务
这是为您提供的免费服务.

一旦你的请求已配对的一个或多个同伴，您将收到通过短信或电话通信。
请注意，要求会根据志愿者的需求得到满足。 我们将尽力尽快满足您的要求。

请至少提前一天的时间来完成请求。
如果您的身体健康有紧急情况，请致电911。
如果您有任何其他疑问，请致电保护唐人街: (646) 543-4055.
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Welcome to Protect Chinatown!
Recently, there have been numerous attacks on the Asian community. Our mission at Protect Chinatown is to provide you with a chaperone(s) when you are outside. The chaperone's task is to walk with you to run your daily errands for a certain time period. This is a free service for you.

Once your request has been paired with one or more chaperones, you will receive communications via text or phone call. Please note that requests are fulfilled on the basis of volunteer availability. We will try our best to fulfill your request as quickly as possible.

Please allow at least one day lead time for requests to be fulfilled.

If this is an emergency regarding your physical health, please call 911.
If there are questions and concerns you need answered, please call Protect Chinatown at (646) 543-4055.
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Are you filling this out for yourself or on behalf of someone else? 您是为自己填写，还是代表他人填写？ *
If you fill out this document on behalf of someone else, what is your full name? 如果您代表他人填写此文件，您的全名是什么？
Client First Name (客户名字) *
Client Last Name (客户姓氏 ) *
Client Date of Birth *
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Email Address (optional) 电子邮件地址（可选）
Client Phone Number (客户电话号码) *
Do you allow Protect Chinatown to reach out to the number above? 您是否授予保护唐人街发短信或打上述电话的权限？ *
What is your preferred method of communication? 您希望采用哪种沟通方式？ *
Required
Languages Spoken 首选语言 *
Required
What date do you require a chaperone? 您需要什么日期陪伴？ *
MM
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DD
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What time do you need a chaperone? (EST) 您什么时候需要伴侣?（美东时间） *
Time
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How many volunteers would you prefer? We will try our best to find volunteer availability. 您想要几个志愿者？ 我们将竭尽所能寻找志愿者。 *
Required
Meeting Address 您的会议地点 *
Destination Address 您的目的地址 *
Disclaimer 免责声明
我知道和 同意 保护唐人街对任何及所有损失和损害的索赔不承担任何责任。 保护唐人街保留在任何时候拒绝志愿者服务的权利，并且没有义务承担与 客户[您] 相关的任何责任。

新型冠状病毒症状：发烧，疲劳，干咳，呼吸困难

1) 我承认并确认我以及我的所有家庭成员目前没有新型冠状病毒的症状，也没有经历过新型冠状病毒的症状。
2) 我承认并确认我以及我的家庭成员在过去30天内未被诊断出新型冠状病毒。
3) 我承认并确认，我以及所有家庭成员在过去30天内未有意接触任何被诊断出新型冠状病毒的人。
4) 我承认并确认，我以及所有家庭成员在过去30天内未曾出国旅行或前往任何被认为是新型冠状病毒感染“热点”的城市。

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I acknowledge that Protect Chinatown is not liable for any and all claims of loss and damage. Protect Chinatown maintains the right to refuse chaperone service at any point in time and is not obligated to adhere to any responsibilities affiliated to the client.

COVID-19 Symptions: Fever, Fatigue, Dry Cough, Difficulty Breathing

1) I acknowledge and affirm that I, as well as all of my household members, do not currently have, nor have experienced the symptoms of COVID-19.
2) I acknowledge and affirm that I, as well as my household members, have not been diagnosed with COVID-19 in the past 30 days. 3) I acknowledge and affirmed that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 30 days.
4) I acknowledge and affirm that I, as well as all household members, have not traveled outside of the country or to any city considered to be a “hot spot” for COVID-19 infections within the past 30-days.
By entering your name below, you acknowledge and affirm all of the points in the disclaimer above. 在下方输入您的姓名，即表示您确认并确认上述免责声明中的所有内容 . *
Thank you! 谢谢您注册
与志愿者匹配后，我们会通过短信/电话给您打电话。 请注意，要求会根据志愿者的需求得到满足。
We will text/call your number once this request has been matched with volunteers. Please note that requests are fulfilled on the basis of volunteer availability.
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