South Bay Chinese School Summer Camp 2024 
南灣中文學校2024 夏令營註冊 

每位學生需要單獨填寫一次。填寫完畢後，請將學費用Zelle支付給：
Each Student needs a separate registration form. Once completed, please Zelle the Tuition to: 
SOUTH BAY CHINESE CULTURE ASSOCIATION 3107800222
無論用Zelle還是支票支付，請提供以下信息：
Please submit the following when making the payment by Zelle or by check, so that credits will be correctly applied to your school account:
  • 學生姓名和家長電話 the student's name and parents' phone number.
  • 如果無法用Zelle支付，請將支票寄給：If unable to pay by Zelle, please mail a check (payable to South Bay Chinese School) to P.O. Box 2611, Palos Verdes, Ca 90274
如有問題請發電子郵件：info@southbaychineseschool.org
For any questions please email: info@southbaychineseschool.org
Email *
Mother Name  母親姓名 *
Father Name  父親姓名

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Chinese Name 學生中文姓名

LAST NAME   姓 (英文) 

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FIRST NAME  名 (英文) 
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Date of Birth  生日  *
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DD
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YYYY
Grade in Fall 2024 - 2024年秋季入學幾年級？ *
Age  年齡 
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Home Address  家庭住址 
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Phone Number  聯繫電話 
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Email Address 電子郵箱 
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Emergency Contact  緊急聯係人姓名 
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Emergency Contact Phone Number  緊急聯係人電話
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Does the student have any allergies or special needs? Please specify.  學生是否有過敏史或需要特殊照顧？請說明。
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Has your child learned Chinese before? (Please specify school name, years of learning).  是否學過中文？（請註明學校，學習年數）
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Medical Insurance company and ID  醫療保險公司和號碼  *
Which weeks are you enrolling in?  您的孩子想參加幾星期的夏令營？
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Required
Total Tuition.   EARLY BIRD DISCOUNT EXTENDED TO 3/31!!  Prices listed are full day camp.  Multi-week discount only applies to full day camp.   Half day camp is $225/week or $200 if registering by 3/31  Payment must be sent by Zelle or postmarked by 3/31 to qualify for early bird discount.  請根據參加週數填寫相應學費（請參考網站宣傳單上的價格）多週折扣僅適用於全天營。 半天營每週為$225，如果在3/31前註冊，則為$200。 付款必須在3/31之前通過Zelle發送或郵戳日期為準以符合早鳥折扣資格。  
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Captionless Image
If paid via Zelle, please include Zelle Reference Number. If paid by check, please include check number.  如果用Zelle付款，請填寫支付後代碼。如果用支票付款，請填寫支票號碼。 
Please specify all other students name(s) if you are enrolling more than one child.  是否註冊其他小孩？請註明其他學生的姓名。
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Please specify if you have any other questions.  如有其他問題請說明 
How did you hear about us?  請問您在哪裡得知此夏令營？
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In the event of illness or injury, I do hereby consent to whatever x-ray examination, anesthetic, medical, surgical or dental diagnosis or treatment and hospital care and emergency transportation considered necessary in the best judgement of the attending physician, surgeon, or dentist and performed under the supervision of a member of the medical staff of the hospital or facility furnishing medical or dental services.
在生病或受傷的情況下，我在此同意接受醫師、外科醫生或牙醫的最佳判斷下認為必要的任何X光檢查、麻醉、醫療、外科或牙科診斷或治療，以及醫院護理和緊急運輸，並在提供醫療或牙科服務的醫院或設施的醫務人員監督下進行。  
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我已閱讀網址為https://www.southbaychineseschool.org/agreement/的協議，並充分了解參與者應遵守所有規定和條例，包括營地期間在上述網頁中指明的規則。根據加州教育法第35330條的規定，我同意放棄對南灣中文學校（SBCS）提出的所有索賠，並使SBCS、其理事會成員、代理人和員工免於任何可能因我子女參與此活動而產生的責任或索賠。  I have read Agreement at https://www.southbaychineseschool.org/agreement/ and I fully understand that participants are to abide by all rules and regulations governing conduct including those indicated in the webpage above during the camp. As provided for in California Education Code Section 35330, I agree to waive all claims against South Bay Chinese School (SBCS) and hold SBCS, its officers, agents and employees, harmless from any and all liability or claims, which may arise out of or in connection with my child's participation in this activity. 
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ELECTRONIC SIGNATURE CONSENT AGREEMENT (Parent/Guardian Acknowledgement and Authorization):

By clicking the 'I Approve' button in the "Electronic Signature Consent" section below, I hereby give permission for my son/daughter to participate in the above-described activity.

A child’s participation in camp activities, events, or programs conducted by South Bay Chinese School, its employees and agents (the “Camp”) involve inherent and unavoidable risks of physical injury or harm, and, despite reasonable precautions, it is impossible for the Camp to enumerate or eliminate all possible risks or guarantee safety. For example, there are risks associated with all physical activities, sports and games, and the use of equipment, which may break, malfunction, or cause injury even when used as intended. DESPITE THESE RISKS, I AUTHORIZE MY CHILD(REN) TO PARTICIPATE IN ALL CAMP ACTIVITIES AND, ON BEHALF OF MYSELF, MY FAMILY, AND MY MINOR CHILD(REN), TO THE FULLEST EXTENT PERMITTED BY LAW, HEREBY WAIVE AND RELEASE ALL CLAIMS, DEMANDS, ACTIONS, CAUSES OF ACTION, COSTS, LOSSES, EXPENSES, MEDICAL BILLS, AND LIABILITIES OF ANY KIND OR NATURE (“CLAIMS”) INCLUDING BUT NOT LIMITED TO CLAIMS OF INJURIES, HARM OR LOSS ARISING FROM MY CHILD(REN)’S CAMP PARTICIPATION, CAMP ACTIVITIES, OR THE CAMP’S NEGLIGENCE, ACTION OR INACTION, WHICH MAY BE ASSERTED BY ANY OF US AGAINST THE CAMP, ITS STAFF, EMPLOYEES, AND AGENTS, AND I HEREBY AGREE TO INDEMNIFY, DEFEND AND HOLD THEM HARMLESS FROM ANY SUCH CLAIMS. 

電子簽名同意協議（家長/監護人確認和授權）： 通過在下面的「電子簽名同意」部分點擊「我同意」按鈕，我特此同意允許我的兒子/女兒參加上述描述的活動。

孩子參加由南灣中文學校及其員工和代理人（以下簡稱「營地」）舉辦的營地活動、活動或計劃涉及固有且無法避免的身體傷害或危害風險，儘管採取了合理的預防措施，但營地無法列舉或消除所有可能的風險或保證安全。例如，與所有體育活動、運動和遊戲以及使用設備相關的風險，即使按照預期使用，這些設備也可能破損、故障或造成傷害。儘管存在這些風險，我授權我的子女參加所有營地活動，並且代表我自己、我的家人和我的未成年子女，盡法律允許的最大範圍，特此放棄並免除所有索賠、要求、行動、原因、費用、損失、支出、醫療費用和任何性質或性質的責任（以下簡稱「索賠」），包括但不限於由我的子女參加營地、營地活動或營地的疏忽、行動或不作為所引起的傷害、危害或損失的索賠，可能由我們中的任何一方向營地、其工作人員、員工和代理人提出，我特此同意賠償、保護並使其免受任何此類索賠的損害。

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I grant permission to South Bay Chinese School, its agents, and its employees the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family while at South Bay Chinese School for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium South Bay Chinese School or the American Camp Association. I hereby release South Bay Chinese School and the American Camp Association and its legal representatives from liability for any violation or claims relating to said images or video.

Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or evaluation with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.

我授權南灣中文學校、其代理人和員工在南灣中文學校拍攝的我的子女、我自己以及我的家庭成員的照片和視頻具有不可撤銷和無限制的權利，用於任何合法目的，包括出版、宣傳、插圖、廣告、貿易或歷史檔案，以任何方式或在任何媒介上，包括南灣中文學校或美國營地協會。我特此釋放南灣中文學校和美國營地協會及其法定代表人，免於就上述圖像或視頻所涉及的任何違規或索賠承擔責任。

此外，我授權使用我子女、我自己或我家庭成員在與我進行的訪談或評估中提供的陳述，無論是否帶有我的名字，用於廣告和宣傳目的，並且對時間限制或地理區域不受限制。我放棄我自己、我的子女以及我的家庭成員因使用這些材料而產生的任何和所有補償權利。

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Cancellation

Cancellation must be notified in writing.

75% of all amounts paid will be issued as credit if cancellation is notified up to two weeks prior to the first day of camp.

50% of all amounts paid will be issued as credit if cancellation is notified less than two weeks prior to the first day of camp.

No credit will be issued if cancellation is notified after the first day of camp.

No refunds and make-up will be issued for missed days.

Prorated amounts paid will be issued as credit or refund if camps are cancelled by South Bay Chinese School.

取消 取消必須以書面形式通知。

如果在營地開始第一天前兩週通知取消，則支付的金額的75%將作為下次學費使用（信用）。

如果在營地第一天前少於兩週通知取消，則支付的金額的50%將作為下次學費使用（信用）。

如果在營地第一天之後通知取消，學費將不退，也沒有學費（信用）。

對於缺席的天數，將不提供退款和補課。

如果由於本校原因取消營地，已支付的按比例計算的金額將作為信用或退款.

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