SweetHome 團體海上靜修之旅登記表

請填妥以下資料

Please Fill in Details Below

靜修之旅日期 *

Retreat Date

MM

/

DD

/

YYYY

中文全名 *

Full Name in English *

聯絡電話 Contact Phone Number *

所屬教會 *

Name of Church

年齡組別（以靜修當天計） *

Age Group (on Day of Retreat)

緊急聯絡人 (請註明關係, 如父母，配偶，親屬等) *

Next of Kin (Please specify the relationship, e.g. parents, spouse, relatives, etc.)

緊急聯絡人電話 Emergency Contact *

本人在過去14天：Over the last 14 days, I : *

有 YES

沒有 NO

有否出現任何新型冠狀病毒的症狀，如發燒、咳嗽、喉嚨痛、氣促或呼吸困難? show any symptoms of COVID19 e.g. fever, cough, sore throat, shortness of breath, or breathing difficulty?

有否曾到訪/過境香港以外地方? have visited / transited outside Hong Kong

有否正在接受香港衛生署的強制檢疫或醫學監察安排? currently under compulsory quarantine or medical surveillance order by the Department of Health of HK?

有否與任何懷疑或確診新型冠狀病毒案個案接觸? have contact with suspected or confirmed cases of COVID19

有否與任何正在接受香港衛生署的強制檢疫或醫學監察安排的人仕接觸? have contact with any person currently under compulsory quarantine or medical surveillance order by the Department of Health of HK?

有 YES

沒有 NO

有否出現任何新型冠狀病毒的症狀，如發燒、咳嗽、喉嚨痛、氣促或呼吸困難? show any symptoms of COVID19 e.g. fever, cough, sore throat, shortness of breath, or breathing difficulty?

有否曾到訪/過境香港以外地方? have visited / transited outside Hong Kong

有否正在接受香港衛生署的強制檢疫或醫學監察安排? currently under compulsory quarantine or medical surveillance order by the Department of Health of HK?

有否與任何懷疑或確診新型冠狀病毒案個案接觸? have contact with suspected or confirmed cases of COVID19

有否與任何正在接受香港衛生署的強制檢疫或醫學監察安排的人仕接觸? have contact with any person currently under compulsory quarantine or medical surveillance order by the Department of Health of HK?

本人在家同住人仕在過去14天 : Over the last 14 days, my household member(s): *

有 YES

沒有 NO

有否出現任何新型冠狀病毒的症狀，如發燒、咳嗽、喉嚨痛、氣促或呼吸困難? show any symptoms of COVID19 e.g. fever, cough, sore throat, shortness of breath, or breathing difficulty?

有否曾到訪/過境香港以外地方? have visited / transited outside Hong Kong

有否正在接受香港衛生署的強制檢疫或醫學監察安排? currently under compulsory quarantine or medical surveillance order by the Department of Health of HK?

有否與任何懷疑或確診新型冠狀病毒案個案接觸? have contact with suspected or confirmed cases of COVID19

有否與任何正在接受香港衛生署的強制檢疫或醫學監察安排的人仕接觸? have contact with any person currently under compulsory quarantine or medical surveillance order by the Department of Health of HK?

有 YES

沒有 NO

有否出現任何新型冠狀病毒的症狀，如發燒、咳嗽、喉嚨痛、氣促或呼吸困難? show any symptoms of COVID19 e.g. fever, cough, sore throat, shortness of breath, or breathing difficulty?

有否曾到訪/過境香港以外地方? have visited / transited outside Hong Kong

有否正在接受香港衛生署的強制檢疫或醫學監察安排? currently under compulsory quarantine or medical surveillance order by the Department of Health of HK?

有否與任何懷疑或確診新型冠狀病毒案個案接觸? have contact with suspected or confirmed cases of COVID19

有否與任何正在接受香港衛生署的強制檢疫或醫學監察安排的人仕接觸? have contact with any person currently under compulsory quarantine or medical surveillance order by the Department of Health of HK?

閣下是否同意生命前線使用閣下的個人資料作活動推廣用途？(我們不會把你的個人資料給予第三方) *

Do you agree that Life Front-line use your personal data for promotional purposes only? (We will not give your personal information to third parties)

同意 Agree

不同意 Disagree

*

本人謹此聲明本人給予生命前線有限公司的資料全部屬實 I hereby declare that all the information provided by me to LFL is accurate to the best of my knowledge

Required

活動條款及細則 Terms & Conditions：

http://en.lifefrontline.org/index.php/services/terms-conditions/

*

本人已閱讀並同意以上「活動條款及細則」 I have read & agree with the above "Terms & Conditions"

Required

確認登記

Registration Confirmation

填妥及提交登記表後，請 WhatsApp 9368 8414 與 Pastor Echo Cheng 鄭世萍傳道 聯絡並安排付款，完成付款後我們會與你確認登記

After submission of the completed registration form, Please Contact Pastor Echo Cheng (WhatsApp 9368 8414) & arrange payment. Your registration will be confirmed after payment is settled.

*

本人已閱讀並明白以上「確認登記」程序 I have read & understand the above "Registration Confirmation" procedure

Required

生命前線有限公司是根據香港《稅務條例》第88條註冊的慈善機構，註冊編號為91/10270。本機構所有收入均按機構章程作慈善用途。

請按「提交」以完成登記表，謝謝 😊

Please press "Submit" to complete the Registration Form. Thank You 😊