基督教家庭服務中心德田幼稚園/幼兒園

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基督教家庭服務中心德田幼稚園/幼兒園

暫託幼兒服務申請表 Application Form for Occasional Child Care Service

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Please fill in and upload all the needed information.

請於家長每月14及28日申請下兩週的暫託服務，以惠及更多有需要的家庭。

費用 Fee︰全日暫託 Full day $64
半日暫託 Half-day $32
每兩小時 A session of 2 hours $16
另加膳食 Additional charges for meals $6.5

選項 1

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1. 兒童資料 Child Information

兒童姓名(中/英) Student Name(Chi/Eng） *

出生日期 Date of Birth *

YYYY

年齡 Age *

性別 Gender *

男Male

女Female

就讀學校 School Attending

2. 父母／監護人資料 Parents / Guardian's Information

家長／監護人姓名 Paren / Guardiant’s Name *

與兒童關係 Relationship with Child *

身份證號碼 Identity Card No. *

職業 Occupation *

電話 Contact No. *

住址 Address *

3. 緊急聯絡資料 Emergency Contact Information

緊急聯絡人姓名 Emergency Contact Name *

與兒童關係 Relationship with Child *

電話 Contact No. *

4. 受託原因 Reason for Application *

照顧者患病 Caregiver is sick

照顧者入院分娩／產前／後檢查／覆診 Caregiver is hospitalized

照顧者探訪患病家人／親戚／朋友 Caregiver need to visit family member(s) or friend(s) who are sick

照顧者陪同患病家人／親戚赴診 Caregiver takes family member(s)/ relatives to consult doctor

家人或近親去世、送殯 Caregiver attends family funeral

照顧者需要照顧家中其他有特別需要的家人或兄弟姊妹 Caregiver takes care of family member(s) with special needs

照顧者要辦理特別事（如見律師、上法庭等）／約見（如見房屋署等／開會）Caregiver has other priority such as meeting etc.

照顧者要參加教育／興趣班或考試 Caregiver needs to take examination/ class/course

照顧者離港／放假／辭職 Caregiver not in Hong Kong/on vacation/has resigned

搬遷／家中裝修 Relocation/Renovation

Other:

5. 轉介來源 Source of Referral *

社會福利署 Social Welfare Department

志願機構 Non governmental department

幼兒中心 Child care centre

自行申請 Apply by oneself

Other:

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