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EBENEZER SCHOOL & HOME FOR VISUALLY IMPAIRED 心光盲人院暨學校
131 Pokfulam Road, Hong Kong
香港薄扶林道131號
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APPLICATION FORM OF GROUP VISIT / VOLUNTEER SERVICES
團體探訪／義工服務申請表
ver 2022 year
Please complete this form as details as possible.
請盡量提供詳細資料。
Name of Applicant:
申請者姓名：
Your answer
Name of Organization / Group:
機構／團體名稱：
Your answer
Position Held:
職位：
Your answer
Telephone:
電話：
Your answer
Fax:
傳真：
Your answer
E-mail:
電郵：
Your answer
Correspondence Address:
通訊地址：
Your answer
You would like to arrange visits or provide volunteer services to the following unit(s):
請選擇欲安排探訪或提供義工服務之單位：
Ebenezer School心光學校—Tel電話: 3159 5400/Fax傳真: 2817 4355
Ebenezer School Boarding 心光學校宿舍—Tel電話: 3159 5438/Fax傳真: 2817 4355
Ebenezer Care & Attention Home心光護理安老院—Tel電話:3159 5408/Fax傳真: 2817 4872
Ebenezer New Hope School / Boarding 心光恩望學校 /宿舍—Tel電話: 2817 0503/Fax傳真: 2872 8418
Ebenezer Child Care Centre 心光幼兒中心—Tel電話: 3159 5403/Fax傳真: 2817 4355
Early Intervention Programme (EIP) 視障幼兒教育支援服務—Tel電話: 3159 5404/Fax傳真: 2817 4355
Christian Ministry福音事工—Tel電話: 3159 5400/Fax傳真: 2872 4355
Date of Proposed Visit:
建議探訪日期：
MM
/
DD
/
YYYY
Time: from......to......
時間：由......至......
Your answer
No. of Persons:
人數：
Your answer
Nature / Occupation of Visitors:
訪客性質／職業：
Your answer
Please indicate reason for Visit:
請註明探訪原因：
*
Recreational services 康樂服務
Gifts delivering 致送禮物
Sight Visit 參觀院舍
Other:
Please provide details if choosing "gift delivery":
如選＂致送禮物
＂
，請寫下是什麼禮物：
Your answer
Have your team members been convicted of any criminal offence in Hong Kong or elsewhere?
團體的義工是否曾在香港或其他地方被裁定干犯刑事罪行?
*
No 沒有
Yes 有
Continuing from the previous question, please provide details if "Yes":
承上題，如填寫"有"，請提供詳請：
Your answer
We declare that we did not have any criminal conviction of sexual offenses.
本團體特此聲明，本團體的義工沒有任何性罪行刑事定罪紀錄。
*
Yes 是
We declare that we will respect National Security Law during my services here.
本團體特此聲明，本團體的義工於義工服務期間會遵守香港維護國家安全法。
*
Yes 是
Please specify the rundown of programme (if possible)
請說明活動計劃大綱（如可以）：
Your answer
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