Alpha Signup 啟發課

名字 *

First

Last

微信 *

电话 *

中文课程

週二晚中文啟發 (6:30 – 8:30) 日期 1/27 -4/14 (教会 – Luke & Sarah))

请选一项 *

我是基督徒（已受洗）
我是基督徒（还没受洗）
我不是基督徒（想探索基督信仰）
我不是基督徒（只想来看看）
无信仰

Do you give us permission to share your contact information with your group leader? (您是否允许我们将您的联系方式分享给您的小组组长) *

Yes (可以)
No (不可以)

Media Disclosure. I understand that church activities may be taped and/or photographed for church use. Entry into any church property or attendance at a church function constitutes consent to be photographed and images to be used for church purposes on the website, printed materials, and videos aired in public venues. (媒体声明. 参加教会活动或进入教会场地, 即表示您同意教会可以拍照或录像, 并在网站, 印刷品或公开播放的视频中使用。) *

I understand (我明白)

Will you need childcare? Childcare is available for children 8 weeks to 10 years of age only. (您需要儿童看护吗？儿童看护服务仅提供给 8周大至10岁的孩子。 *

Yes (需要)
No (不需要)

Number of Children (孩子人数)

1
2
3
4

Child 1- List the first and last name of child number 1 (孩子1 — 请填写孩子的姓名) *

Child 1- List the date of birth for child number 1 (孩子1 — 请填写孩子的出生日期 ) *

Child 1- List any allergies for child number 1. Please type NA if not applicable (孩子1 — 请列出孩子的任何过敏情况。如无，请填写 NA) *

example: peanut allergy

Child 2- List the first and last name of child number 2 (孩子2 — 请填写孩子的姓名) *

example: Bobby Jones,

Child 2- List the date of birth for child number 2 (孩子2 — 请填写孩子的出生日期) *

Child 2- List any allergies for child number 2 (孩子2 — 请列出孩子的任何过敏情况。如无，请填写 NA) *

example: peanut allergy

Child 3- List the first and last name of child number 3 (孩子3 — 请填写孩子的姓名) *

example: Bobby Jones,

Child 3- List the date of birth for child number 3 (孩子3 — 请填写孩子的出生日期) *

example: 11/15/2009

Child 3- List any allergies for child number 3 (孩子3 — 请列出孩子的任何过敏情况。如无，请填写 NA) *

example: peanut allergy

Child 4- List the first and last name of child number 4 (孩子4 — 请填写孩子的姓名) *

example: Bobby Jones,

Child 4- List the date of birth for child number 4 (孩子4 — 请填写孩子的出生日期) *

example: 11/15/2009

Child 4- List any allergies for child number 4 (孩子3 — 请列出孩子的任何过敏情况。如无，请填写 NA) *

example: peanut allergy

If you have more than four children requiring childcare please list the information for those additional children below. Include the following information for each additional child: first and last name, date of birth, and any allergies or special needs. (如果您有超过四个需要儿童看护的孩子，请在下面填写额外孩子的信息。每位额外孩子请提供以下信息：姓名（名和姓）、出生日期，以及任何过敏情况或特殊需求。)

Do any of your children require special needs assistance? (您的孩子中是否有需要特殊帮助的？)

Are you bringing an Epi pen for your child? (您会为孩子带上肾上腺素注射笔（EpiPen）吗？) *

Name of children with Epi pen. (携带肾上腺素注射笔（EpiPen）的孩子姓名) *

Does your child have a history of seizures? (您的孩子是否有癫痫或抽搐的病史？) *

Media Disclosure: In order to receive childcare services at Grace Fellowship, please read and consent to the following: “I understand that church activities may be taped and/or photographed for church use. Entry into any church property or attendance at a church function constitutes consent to be photographed and images to be used for church purposes on the website, printed materials, and videos aired in public venues.” (媒体声明为了使用Grace 教会的儿童看护服务，请阅读并同意以下内容： “我明白教会的活动可能会被录音、录像或拍照，并用于教会的需要。进入任何教会场所或参加教会活动，即表示我同意被拍照或录像，并同意这些影像可用于教会网站、印刷品以及在公共场合播放的视频中。”) *

I agree (我同意)

Childcare Policy Agreement: In order to receive childcare services at Grace Fellowship, please read and consent to the following: Childcare Policies* By reserving a space for childcare, I agree that my children will be utilizing childcare for every session of the group. If my child does not need childcare for a session, I agree to inform the Childcare Coordinator at least one week prior to the session. If my child is unable to attend due to a family member being sick, I will contact the Childcare Coordinator as soon as possible. If my child is absent 3 times without giving the Childcare Coordinator one week prior notice, the Childcare Coordinator and Ministry Contact will decide if the church can continue to provide childcare for my child. (儿童看护政策协议为了使用Grace教会的儿童看护服务，请阅读并同意以下内容：儿童看护政策通过预留儿童看护名额，我同意我的孩子将在每一次小组活动中使用儿童看护服务。如果我的孩子在某次活动中不需要儿童看护，我同意至少在活动开始前一周通知儿童看护协调员。如果由于家庭成员生病导致我的孩子无法参加，我会尽快联系儿童看护协调员。如果我的孩子在没有提前一周通知儿童看护协调员的情况下缺席三次，儿童看护协调员和事工联络人将决定教会是否可以继续为我的孩子提供儿童看护服务。) *

Yes, I agree to the above Childcare Agreement (是的，我同意上述儿童看护政策协议)
No, I would like to discuss these policies further (不同意，我希望进一步讨论这些政策)

Name of children needing special assistance. (需要特殊帮助的孩子姓名) *