Kiwassa Senior Programs - Membership Registration Form (April 1, 2024-March 31, 2025)奇華沙耆英組- 會員登記表(2024年4月1日到2025年3月31日)
Important Note

All seniors, including old members who joined previous years, senior volunteers, TAPS participants, current active participants and anyone accessing the service are required to fill out this membership form.

*You are only required to answer the questions with red star(*). For old members, you don't need to answer the questions that are for new members. All new members are required to answer all questions. 

*All the information that you give us will only be shared within our senior program staff team. We will not give your information to other people without your permission unless there is a life-threatening situation. 

*Please remember to read and consent to the terms “Becoming a member of Kiwassa senior programs" and  "ACCEPTANCE OF RISK, AND CONSENT " on the bottom of the page!

*Please remember to click "submit" on the bottom of the page when you have completed the form.

For all new members, a staff will send you a welcome email and contact you after you've registered.

If you need help submitting the form or you have any questions or concerns, please contact seniorsprograms@kiwassa.ca, call Cherrie at 604-306-2088 or Kammy at 604-306-9148. 

重要資訊

所有耆英,包括前幾年加入的耆英組的會員、義工、TAPS 參加者、目前的活躍參與者以及任何使用服務的人都必須填寫此會員表格。

*您只需回答紅色星(*)的問題。 對於舊會員,您無需回答新會員的問題。 所有新會員都必須回答所有問題。

*您提供給我們的所有資訊將僅被我們的耆英工作人員團隊傳取。 未經您的許可,我們不會將您的資訊提供給其他人,除非出現危及生命的情況。

*請記得閱讀並同意頁面底部的“成為奇華沙耆英組會員”條款和“接受風險並同意”!

*填寫完表格後,請記得點擊頁面底部的「提交」。

對於所有新會員,工作人員將向您發送一封歡迎電子郵件,並在您註冊後與您聯繫。

如果您需要協助提交表格,或者您有任何問題或疑慮,請聯絡 Seniorsprograms@kiwassa.ca,致電 Cherrie(604-306-2088)或 Kammy(604-306-9148)。

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Last Name 
*
First Name
*
Date of Birth 
出生日期
*
MM
/
DD
/
YYYY
Phone #
電話#
*
Email
電郵
Home Address
地址
*
Emergency Contact Name 
緊急聯絡人
*
Emergency Contact Phone # 
緊急聯絡人電話#
*
Photo Consent (for promotion purpose)  
照片同意 (用於宣傳目的)
*
Methods of Payment:  Check one to choose your method of payment
付款方式: 選一項以選擇您的付款方式
*
Please choose one of the following that best applies to you: 
請選擇以下最適合您的選項之一:
*
1. Do you have any dietary restrictions/preference (New members only*) 
1. 您有飲食限制/偏好嗎?(限新會員*)
2. Areas of Challenges (Check all that apply) (New members only*)  
目前面對的困難 (勾選所有適用項,限新會員*)
3. Areas of Interest (Check all that apply) (New members only*)  
興趣領域 (勾選所有適用項,限新會員*)

4. Membership Agreement 會員協議

Becoming a member of Kiwassa senior programs: I know that I will get a free lunch pass for senior lunch at Kiwassa. I understand that I need to pay $5 (except TAPS participants/ Active volunteer) for my annual membership (April 1, 2024 - March 31,2025) . I understand that I can talk to senior program staff if I have financial difficulties, question or concerns about the fees. I understand that additional fees may apply to some in-person programs such as, line dance classes, lunch program, ESL class, and etc. I also understand that I have free access to some in-person programs such as arts & craft, Qi Gong & Morning exercise, walking club and etc. Moreover, I understand that I have access to other programs at Kiwassa and community resources.

成為奇華沙耆英組的成員:我知道我會得到一張免費的午餐票可以在奇華沙中心的耆英午餐享用。 我了解我需要為我的年度會員費支付 5 元(2024 年 4 月1日至 2025 年 3 月31日)(TAPS 參與者/活躍義工除外)。我明白,如果我有經濟困難、對費用問題或疑慮,我可以與耆英組的工作人員交談。我了解,一旦我登記了會員,我就可以免費參加所有線上的活動。我了解有些實體活動會可能會收取額外費用,例如:排排舞班、午餐、英文班等。我還了解到我可以免費參加一些實體活動,例如:手工班、氣功&早操、步行俱樂部等。此外,我知道我可以參加和使用奇華沙其他部門的活動和社區資源。

Acceptance of Risk, and Consent 

接受風險並表示同意:                                          

I acknowledge that there are risks, dangers, and hazards associated with my participation in Kiwassa programming, including online programs, including, but not limited to: impact and collision with other participants during recreation activities; contraction of a contagious disease including, but not limited to, COVID-19; adverse weather conditions; loss of balance; falling; failure to participate in activity safely within one's own ability; consumption of food and drink, whether made by professionals or by non-professionals; and negligence of other participants or Kiwassa staff. Participants are expected to be respectful and considerate towards other participants, Kiwassa staff including all instructors, and external partner organization instructors. Participants are expected and required to follow the directions of all instructors. MEDICAL EMERGENCIES: In the event of an accident, injury or illness involving the registrant, and immediate contact by Kiwassa with a designated contact cannot be made, I hereby authorize and grant permission to Kiwassa staff to secure proper medical treatment and authorize on the registrant’s behalf all procedures, including, without limitation, admission to an emergency unit, hospital and treatment therein, ordering of x-rays, tests or treatment, injections, anesthesia and/or surgery, as deemed necessary by the attending medical professional(s). I agree not to hold Kiwassa responsible for any costs or injury arising out of an emergency situation.

我知道參與奇華沙的活動(包括在線課程)存在一定的風險和危險,包括但不限於:娛樂活動期間與其他參與者的碰撞;傳染性疾病的感染,包括但不限於COVID-19;不利的天氣條件;失去平衡;跌倒;無法在自己的能力範圍內安全地參加活動;食品和飲料的消費,無論是由專業人員還是由非專業人員進行的;以及其他參與者或奇華沙工作人員的疏忽。奇華沙希望參與者對其他參與者,包括所有講師在內的奇華沙的工作人員以及外部合作夥伴組織的講師表示尊重和體諒,參加者被期望並要求遵循所有課程教師的指示。

緊急醫療事故:如果發生事故,受傷或生病,並導致註冊人無法立即與緊急聯繫人取得聯繫,我特此授權Kiwassa工作人員以確保我得到適當的治療,並代表註冊人授權所有程序,包括但不限於,急診醫療專業人員認為必要的,包括進入急診室,醫院及其中的治療,照X光片,進行檢查或治療,注射,麻醉和/或手術。我同意不對奇華沙承擔因緊急情況引起的任何費用或傷害負責。

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