IMPORTANT: Please read the following before filling the form
1) You must be the legal guardian to register your youth . By submitting this form, you certify that you are the legal guardian of the youth you are registering and that the information you provided is true.
2) If you are registering more than one youth, please submit a separate registration for each child.
重要: 請在填寫表格前，請閱讀以下事項:
1) 你必需是報名青少年的合法監護人 。當遞交此表格時，這代表你是青少年的合法監護人和以下一切資料實屬真實。
2) 如你有兩個或以上 青少年 參加，請個別填寫表格
Youth's Information 青少年資料
Grade
*
Select Option
6th
7th
8th
9th
10th
11th
12th
Emergency Contact (other than parents) 緊急聯繫人 (不可放父母)
Permission to Participate and Receive Emergency Medical Treatment 允准參加及接受緊急醫藥治療
I give permission for the above mentioned youth to participate in the activities, programs, and trips (“Activities”) sponsored by CHINESE EVANGELICAL FREE CHURCH OF LOS ANGELES (“CEFC”). In case of a medical emergency during such Activities, I authorize CEFC staff, agents, and/or volunteers to request for or to deliver my youth to emergency medical services. In a medical emergency, these persons may also perform first aid or life saving techniques (including but not limited to CPR) that can reasonably be performed by persons who are not medical professionals. In a medical emergency, I give consent for my youth to receive professional medical treatment reasonably necessary for my youth’s health, and I authorize CEFC staff, agents, and/or volunteers to consent on my behalf to emergency medical treatment for my youth. Treatment may include, but is not limited to, anesthesia, x ray, or medical procedures as advised by a physician. I accept all financial responsibilities concerning any medical treatment in such circumstances. In the case of a non-emergency illness, non-emergency injury, or disciplinary situation, I also accept responsibility to have my youth picked up promptly after being notified of such. This consent is effective for the period of one (1) year from the signing date. 我允准我上述青少年參加由羅省華人播道會(下稱“播道會”)安排的活動、節目和旅行(下稱“活動”)。如果在此類活動中發生緊急醫療情況，我授權給播道會職員、代理人和/或義工將我的 青少年 送往緊急醫療服務。在緊急醫療情況下，這些人還可以進行急救或救生技術(包括但不限於心肺復甦術)，這些技術可以由非醫療專業人員合理地執行。在緊急醫療情況下，我同意我的 青少年 接受對其健康作合理而必要的專業醫療，並且我授權給播道會的職員、代理人和/或義工代表，為我的 青少年 進行緊急醫療。治療可能包括但不限於麻醉、X 光檢查或醫生建議的醫療程序。在這種情況下，我承擔有關任何醫療所需的財務責任。而若出現非緊急病況、非緊急受傷，或紀律處分的需要，在接到通知後，我也會承擔責任立即接回我的 青少年 。本同意書自簽署之日起一 年內有效。
Release of Liability 放棄追究責任聲明
I acknowledge that my youth’s participation in these Activities carries certain risks of accidents or illness. I expressly assume the risks to my youth for my youth to participate in these Activities, whether such risks are known or unknown to me at this time. In exchange for my youth’s participation in these Activities, I hereby release CEFC, its staff, agents, and/or volunteers from any liability or claims of liability arising from any injury or illness incurred by my youth resulting from my youth’s participation in these Activities. This release covers all incidents occurring within the period of one (1) year from the signing date. 我認知我的 青少年 在參加這些活動時，會有一定的意外或疾病風險。我明確承擔我的 青少年 參加這些活動的風險，這包括我目前已知或未知的風險。為讓我的 青少年 能參與這些活動，我特此放棄追究播道會、播道會職員、代理人和/或義工，因我的 青少年 參加這些活動出現任何受傷或疾病而導致的任何責任或索賠。此免責聲明由簽名之日起一年內有效，保障在此期間發生的任何事故之責任追討。
Permission to Use Photos and Video 允准使用肖像照片和視頻
I give permission for CEFC, its staff, agents, and/or volunteers to use photos and/or video of my youth in church publications such as newsletters, church website, or other related areas (including, but not limited to, social media). I may revoke this permission in writing at any time by sending such writing to CEFC at 1111 S. Atlantic Blvd., Monterey Park, CA 91754 by certified mail. Until I have revoked permission in writing, my permission for said use shall remain effective. 我允准播道會、其職員、代理人和/或義工在教會出版的刊物(如教會通訊、教會網站或其他相關領域，包括但不限於社交媒體)中使用我 青少年 的照片和/或視頻。我可以隨時以郵件書面形式撤銷此許可，地址為 1111 S. Atlantic Blvd., Monterey Park, CA 91754。直至播道會收到我的書面撤銷許可之前，我對這項允准仍然有效。
Parent/Guardian's Signature 家長/監護人簽名
DISCLAIMER: By entering my full name below, I am electronically signing this document to confirm that I have read, understood, and agree to the terms of this parental consent form. This electronic signature holds the same legal weight as my handwritten signature on this document. 免責聲明：通過在下面輸入我的全名，我在此電子簽署本文件，以確認我已閱讀、理解並同意本家長同意書的條款。本電子簽名與我在此文件上的手寫簽名具有同等法律效力。
