summer day camp REGISTER10 - Amazon Web Servicesmedia.fbny.org.s3.amazonaws.com/text/2010-1t/... ·...
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2010 信心兒童夏令營報名表 2010 Faith Summer Day Camp Registration Form 英文姓名 English Name 中文姓名 Chinese Name 性別 Sex 年齡 Age 生日 Date of Birth 年級 Grade 1. _____________, ________________ last name 姓 first name 名字 _______________ ____ ____ ____/____/_____ _____ 2. _____________, ________________ last name 姓 first name 名字 _______________ ____ ____ ____/____/_____ _____ 3. _____________, ________________ last name 姓 first name 名字 _______________ ____ ____ ____/____/_____ _____ 1. 地址 Address: ________________________________City: _____________State: _____Zip: ________ 2. 電話 Telephone#: 住家(Home): ____________________ 辦公室(Office): ____________________ 3. 緊急連絡人姓名、電話 In case of emergency, contact person & phone #: 姓名 Name: ___________________住家電話(H)___________________ 手機(C) ___________________ 4. 需要 ESL 教學嗎 Need ESL?： 否 (No) 是 (Yes) 5. 所屬教會 Church Affiliation:__________________________________ 6. 在家使用語言 Language Used at Home: 英語(English) 國語(Mandarin) 粵語(Cantonese) 溫州語(Wenzhou) 福州語(Fuzhou) 其它(Others): _______________________________ 7. 是否有任何敏感 Any Allergies? 沒有 No 有 Yes: ______________________________________ 8. 家庭醫生姓名 Family Doctor‘s Name: ______________________電話 Tel: ________________________ 9. 上課日期 Weeks Registered: 自(from) ____/____ 至(to) ____/____（第____週 ~ 第____週 // wk____ ~ wk____） 二週(2 weeks) 四週(4 weeks) 六週(6 weeks) 八週(8 weeks) 其他( _____週) 10.需要車輛接送嗎 Transportation Needed?否 No 是 Yes 接來 pick up 送回 send back 車輛接送只限某些區域。如是屬其他區域，請留下電話聯絡 (Limited Areas, Leave Tel# if needed) Flushing / College Point / Whitestone - 11354, 11355, 11356, 11357, 11358, 11365, 11366, 11367 Bayside - 11360, 11361, 11362, 11364 Forest Hills – 11374, 11375 11.需要早到或晚走嗎 Early Arrival or Late Pickup? 否 No 是 Yes : 早到 Early arrival 晚走 Late pickup 12.可以接我孩子之人的名字 Names that can pick up my child ：____________________________________________ 13.如何得知本兒童夏令營 How do you know about this summer camp? 報紙 (Newspaper) 廣播 (Radio) 朋友介紹 (Friends) 其他 (Others) _________________ 此欄由工作人員填寫 ( Office Use Only) 14. 付費 (Payment)：$_______________ 現金 (Cash) ____________ 支票 (Check) # __________________ 15. 接收註冊表之人姓名 (Recipient of this registration & payment)：__________________ 日期(Date): We, _____________________( Parent’s name 家長姓名) do hereby grant permission for ____________________ (Student’s Name 學生姓名) to attend Faith Bible Church Community Center School sponsored by FAITH BIBLE Inc. and take full responsibility if anything should happen to my child(ren). I hereby absolve FAITH BIBLE INC. of any legal responsibility. __________________________________ __________________ 家長簽名 Parent‘s or Guardian’s Signature 日期 Date 我已清楚明白並接受信心兒童夏令營退費和請假規則 I fully understand and accept the refund policy and absent policy of Faith Summer Day Camp. __________________________________ __________________ 家長簽名 Parent‘s or Guardian’s Signature 日期 Date ………………………………………………………………………………………………………………………………………………………………………………………. 日期 Date：7/6/2010 – 8/27/2010 週一至週五，一共八週 (Monday through Friday, 8 weeks in total) 時間 Time： 9:00 A.M. - 5:00 P.M. 招收學生年齡 Student‘s Age: 4-14 註冊費 Registration Fee: $50 (恕不退還 nonrefundable, 包括外出旅行保險費 including trip insurance) 學費 Tuition Fee: 包括英文閱讀、文法、數學教材、外出旅行門票、夏令營 T 恤、午餐及午後點心 (including materials of reading, math, & grammar, T shirt, trips, lunch and afternoon snacks) (1) 八週(8 weeks) $730 (2) 六週(6 weeks) $630 (3) 四週(4 weeks) $530 (4) 二週(2 weeks) $430 同一家庭特價 Same Family Member Discount: 同一家庭第二個孩子減免$100，第三個孩子半價 (Within the same family, 2 nd child $100 less, 3 rd child half price) 五月底以前註冊，每個孩子再各減免$50（Registered before May 31st, additional $50 discount each child） 提供早到或晚走的服務 Early Arrival or Late Pick-Up Available: $1/半小時 ($1per 1/2 hr.) 車費 Transportation Fee: 每單趟 $5 ($5 one single trip) 信心兒童夏令營退費規則 Faith Summer Day Camp Refund Policy: 1. 註冊費一旦報名之後恕不退還。After register the program, registration fee will not be refund. 2. 學生註冊後，6/20 以前因故申請退出夏令營，學費全額退還，6/20 以後申請者，將退還剩餘學費 的 80%。We will refund tuition 100% if the withdrawal applied before 6/20. After 6/20, the refund is 80% of the remaining tuition for all withdrawal. 3. 若註冊後申請退出，本學校將會退還剩餘的車費。Faith Summer Day Camp will refund the entire remaining transportation fee for all withdrawal after registration. 報名請洽 Registration: 信心聖經會 FAITH BIBLE INC. 133-20 41st Ave. Flushing, NY 11355 Tel.: (718)961-9355 Fax: (718)886-8676 支票抬頭請寫 Please make check payable to: FAITH BIBLE INC.
Transcript of summer day camp REGISTER10 - Amazon Web Servicesmedia.fbny.org.s3.amazonaws.com/text/2010-1t/... ·...
2010 信心兒童夏令營報名表 2010 Faith Summer Day Camp Registration Form
英文姓名 English Name 中文姓名Chinese Name 性別 Sex 年齡 Age 生日 Date of Birth 年級 Grade
1. _____________, ________________ last name 姓 first name 名字
_______________
____
____
____/____/_____
_____
2. _____________, ________________ last name 姓 first name 名字
_______________
____
____
____/____/_____
_____
3. _____________, ________________ last name 姓 first name 名字
_______________
____
____
____/____/_____
_____
1. 地址 Address: ________________________________City: _____________State: _____Zip: ________ 2. 電話 Telephone#: 住家(Home): ____________________ 辦公室(Office): ____________________ 3. 緊急連絡人姓名、電話 In case of emergency, contact person & phone #: 姓名 Name: ___________________住家電話(H)___________________ 手機(C) ___________________ 4. 需要 ESL 教學嗎 Need ESL?： 否 (No) 是 (Yes) 5. 所屬教會 Church Affiliation:__________________________________ 6. 在家使用語言 Language Used at Home: 英語(English) 國語(Mandarin) 粵語(Cantonese) 溫州語(Wenzhou) 福州語(Fuzhou) 其它(Others): _______________________________ 7. 是否有任何敏感 Any Allergies? 沒有 No 有 Yes: ______________________________________ 8. 家庭醫生姓名 Family Doctor‘s Name: ______________________電話 Tel: ________________________ 9. 上課日期 Weeks Registered: 自(from) ____/____ 至(to) ____/____（第____週 ~ 第____週 // wk____ ~ wk____） 二週(2 weeks) 四週(4 weeks) 六週(6 weeks) 八週(8 weeks) 其他( _____週) 10.需要車輛接送嗎 Transportation Needed?否 No 是 Yes 接來 pick up 送回 send back
車輛接送只限某些區域。如是屬其他區域，請留下電話聯絡 (Limited Areas, Leave Tel# if needed) Flushing / College Point / Whitestone - 11354, 11355, 11356, 11357, 11358, 11365, 11366, 11367
Bayside - 11360, 11361, 11362, 11364 Forest Hills – 11374, 11375 11.需要早到或晚走嗎 Early Arrival or Late Pickup? 否 No 是 Yes : 早到 Early arrival 晚走 Late pickup 12.可以接我孩子之人的名字 Names that can pick up my child ：____________________________________________ 13.如何得知本兒童夏令營 How do you know about this summer camp? 報紙 (Newspaper) 廣播 (Radio) 朋友介紹 (Friends) 其他 (Others) _________________
此欄由工作人員填寫 ( Office Use Only) 14. 付費 (Payment)：$_______________ 現金 (Cash) ____________ 支票 (Check) # __________________ 15. 接收註冊表之人姓名 (Recipient of this registration & payment)：__________________ 日期(Date):
We, _____________________( Parent’s name 家長姓名) do hereby grant permission for ____________________ (Student’s Name學生姓名) to attend Faith Bible Church Community Center School sponsored by FAITH BIBLE Inc. and take full responsibility if anything should happen to my child(ren). I hereby absolve FAITH BIBLE INC. of any legal responsibility. __________________________________ __________________ 家長簽名 Parent‘s or Guardian’s Signature 日期 Date
我已清楚明白並接受信心兒童夏令營退費和請假規則 I fully understand and accept the refund policy and absent policy of Faith Summer Day Camp. __________________________________ __________________ 家長簽名 Parent‘s or Guardian’s Signature 日期 Date ………………………………………………………………………………………………………………………………………………………………………………………. 日期 Date：7/6/2010 – 8/27/2010 週一至週五，一共八週 (Monday through Friday, 8 weeks in total) 時間 Time： 9:00 A.M. - 5:00 P.M. 招收學生年齡 Student‘s Age: 4-14 註冊費 Registration Fee: $50 (恕不退還 nonrefundable, 包括外出旅行保險費 including trip insurance) 學費 Tuition Fee: 包括英文閱讀、文法、數學教材、外出旅行門票、夏令營 T 恤、午餐及午後點心 (including materials of reading, math, & grammar, T shirt, trips, lunch and afternoon snacks)
(1) 八週(8 weeks) $730 (2) 六週(6 weeks) $630 (3) 四週(4 weeks) $530 (4) 二週(2 weeks) $430 同一家庭特價 Same Family Member Discount: 同一家庭第二個孩子減免$100，第三個孩子半價 (Within the same family, 2nd child $100 less, 3rd child half price) 五月底以前註冊，每個孩子再各減免$50（Registered before May 31st, additional $50 discount each child）
提供早到或晚走的服務 Early Arrival or Late Pick-Up Available: $1/半小時 ($1per 1/2 hr.) 車費 Transportation Fee: 每單趟 $5 ($5 one single trip) 信心兒童夏令營退費規則 Faith Summer Day Camp Refund Policy: 1. 註冊費一旦報名之後恕不退還。After register the program, registration fee will not be refund. 2. 學生註冊後，6/20 以前因故申請退出夏令營，學費全額退還，6/20 以後申請者，將退還剩餘學費的 80%。We will refund tuition 100% if the withdrawal applied before 6/20. After 6/20, the refund is 80% of the remaining tuition for all withdrawal. 3. 若註冊後申請退出，本學校將會退還剩餘的車費。Faith Summer Day Camp will refund the entire remaining transportation fee for all withdrawal after registration.
報名請洽 Registration: 信心聖經會 FAITH BIBLE INC. 133-20 41st Ave. Flushing, NY 11355
Tel.: (718)961-9355 Fax: (718)886-8676 支票抬頭請寫 Please make check payable to: FAITH BIBLE INC.
信心兒童夏令營 Faith Summer Day Camp
活動與上課內容(Activities and Classes): 快樂聖經營、英文閱讀、數學、各式球類活動、博物館參觀、玩水活動、動物園、科學館、保齡球、棋類、電影、
美勞手工、溜冰、音樂...等(Joyful Bible Camp, Reading, Math, Sports, Museums, Water Fun, Zoo, Hall of Science, Bowling, Chess and Checker, Movies, Arts and Crafts, Roller Skating, Music ... etc.)
信心聖經教會(Faith Bible Church) 133-20 41 Ave. Flushing, NY 11355
Tel.: (718) 961-9355 Fax: (718) 886-8676
Parent Information Statement
Faith Summer Day Camp at 133-20 41st Ave. Flushing, NY 11355
This camp is licensed by the New York City Department of Health and Mental Hygiene (NYCHC Section 48.29) and is inspected twice yearly. The inspection reports are filed at the Bureau of
Food Safety and Community Sanitation.
Lunches are free and provided by USDA through the Office of School Food and Nutrition Services,
NYC Board of Education
