家和醫療報告解讀服務 CFSO Medical Report Interpretation Service

(Template)2024-07-27 Niagara Trip & Outlet 尼加拉瓜及Outlet一日遊
Date: 2024-07-27 (Saturday)
Departure/Arrival Time:7:45am/06:00pm
Gathering/Dismissal place: Agincourt Walmart Parking spot, 3850 Sheppard Ave E, Scarborough, ON, M1T 3L3
Language of introduction: Chinese
Transportation Cost: $35CAD
Eligibility: PR holders and their families*

*In the participating household, permanent residents must constitute the majority. For example, in a family of 5, there must be at least 3 members holding PR cards.

日期：2024-07-27 (周六)
出發／解散時間：早上7:45/下午06:00
集合／解散地點：愛靜閣Walmart 停車場, 3850 Sheppard Ave E, Scarborough, ON, M1T 3L3
介紹語言：中文
交通費用：$35CAD
參加資格：永久居民及其家庭*

*參加家庭人數中永久居民必須佔大多數，例如：5人家庭中必須有至少3名成員持有楓葉卡

Trip plan 行程*:
Agincourt Walmart-> Niagara-on-the-Lake-> Niagara Falls ->Outlet Collection at Niagara->Agincourt Walmart
*Lunch will not be included 不包括午餐
You will receive the email with a payment method after validating your information successfully.
我們完成資料確定後，你將會收到確定付費的電郵。

*Your spot will only be guaranteed upon our confirmation and receive of your payment
*你的名額只會在我們確認及收取你的費用後才確定

Inquiry查詢:
Legal Name (English)*

Legal First Name 名字 Legal Last Name 姓氏
Preferred name(English)
暱稱
Birthday 生日*

YearMonthDay
Date
Phone Number 聯絡電話*
Please enter a valid phone number.
Email 電郵*
example@example.com
Gender 性別*

Male 男Female 女Other 其他
POSTAL CODE OR ADDRESS 郵編或地址*
List Current & Chronic Illnesses 列明現時或長期病患*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
List Allergies列明致敏原*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
Emergency Contact Person緊急聯絡人名字*
Relationship with registrant 與登記人關係*
Emergency Contact Number 緊急聯絡電話號碼*
Why Immigration, Refugees and Citizenship Canada (IRCC) collects personal information?
為什麼加拿大移民、難民及公民部(IRCC)要收集個人資訊?

You can access the notice issued by IRCC through the following link to learn more:
你可以透過以下連結瀏覽由IRCC發佈通告知道更多:

English version
Traditional Chinese version 中文版本

For details, please consult 詳情請瀏覽
http://www.cic.gc.ca/english/department/atip/index.asp
Immigration Status in Canada 在加拿大的身份*

I am a Canadian Permanent Resident. 我是加拿大永久居民(PR)I am a Convention Refugee.我是公約難民I am Live-in Caregiver 我是住家保姆I am holding Visa Student 我持有學生簽證I am holding Work Permit 我持有工作簽證
PR Card Number 楓葉卡卡號*
You can find your PR number on your COPR/ PR Card. (8 or 10 digit) 你可以在加拿大移民部(IRCC)給您的PR確認信/楓葉卡上找到您的 PR 號碼。
UCI number*
You can find your UCI number on letters sent by IRCC. 你可以在加拿大移民部(IRCC)給您的信上找到您的 UCI 號碼。
清晰楓葉卡正面清晰照片 Clear image of PR card *

Cancelof
上載難民身分證明文件 Upload refugee status documentation*

Cancelof
上載身分證明文件 Upload Status documentation*

Cancelof

Pre-service needs assessment 服務前需要評估

In order to streamline the registration process, if you have previously received our services and completed the pre-service needs assessment, you may skip the assessment section. Otherwise, please take a few minutes to complete it so that we can provide services and activities best suited to your needs. Thank you!為了簡化登記流程，若你在2025年4月1日至今日曾報名參加我們的服務，又填寫過服務前需要評估，我們會為你略過評估；相反，我們邀請你花時間完成以下評估，以便我們能為你提供更適合的活動及服務，感謝！
Did you previously receive our services and complete the pre-service needs assessment? 你是否在2025年4月1日至今日曾報名參加我們的服務，又填寫過服務前需要評估？*

Yes 是No 否

Pre-service needs assessment for employment services 就業服務：服務前需要評估
What is your employment status? 您的就業狀況是什麼？*

Currently not working 目前未就業Employed in Canada, but not in their profession 在加拿大就業，但並非從事原本的專業Employed in Canada, in their profession 在加拿大就業，並從事原本的專業Started a business/self-employed 創業／自僱人士
What is your intended occupation? 您打算從事的職業是什麼？ *
Please find your occupation classifications on 你可以在以下網站找到你職業分類 https://noc.esdc.gc.ca/?GoCTemplateCulture=en-CA

How many family members will go with you? (Including yourself) 有多少家庭成員會與你一同出席活動？（包括自己）
If you have other participants who are not your family members, please fill out another form. 如你有其他非家庭成員的參加者，請填寫另外表格。

Legal Name (English)*

Legal First Name 名字 Legal Last Name 姓氏
Preferred name(English)
暱稱
Birthday 生日*

YearMonthDay
Date
Phone Number 聯絡電話*
Please enter a valid phone number.
Email 電郵*
example@example.com
Gender 性別*

Male 男Female 女Other 其他
List Current & Chronic Illnesses 列明現時或長期病患*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
List Allergies列明致敏原*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
Emergency Contact Person緊急聯絡人名字*
Relationship with registrant 與登記人關係*
Emergency Contact Number 緊急聯絡電話號碼*
Immigration Status in Canada 在加拿大的身份*

I am a Canadian Permanent Resident. 我是加拿大永久居民(PR)I am a Convention Refugee.我是公約難民I am Live-in Caregiver 我是住家保姆I am holding Visa Student 我持有學生簽證I am holding Work Permit 我持有工作簽證
PR Card Number 楓葉卡卡號*
You can find your PR number on your COPR/ PR Card. (9 or 12 digit) 你可以在加拿大移民部(IRCC)給您的PR確認信/楓葉卡上找到您的 PR 號碼。
UCI number*
You can find your UCI number on letters sent by IRCC. 你可以在加拿大移民部(IRCC)給您的信上找到您的 UCI 號碼。
清晰楓葉卡正面清晰照片 Clear image of PR card *

Cancelof
上載難民身分證明文件 Upload refugee status documentation*

Cancelof
上載身分證明文件 Upload Status documentation*

Cancelof

Information for 5th participant
Legal Name (English)*

Legal First Name 名字 Legal Last Name 姓氏
Preferred name(English)
暱稱
Birthday 生日*

YearMonthDay
Date
Phone Number 聯絡電話*
Please enter a valid phone number.
Email 電郵*
example@example.com
Gender 性別*

Male 男Female 女Other 其他
List Current & Chronic Illnesses 列明現時或長期病患*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
List Allergies列明致敏原*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
Emergency Contact Person緊急聯絡人名字*
Relationship with registrant 與登記人關係*
Emergency Contact Number 緊急聯絡電話號碼*
Immigration Status in Canada 在加拿大的身份*

I am a Canadian Permanent Resident. 我是加拿大永久居民(PR)I am a Convention Refugee.我是公約難民I am Live-in Caregiver 我是住家保姆I am holding Visa Student 我持有學生簽證I am holding Work Permit 我持有工作簽證
PR Card Number 楓葉卡卡號*
You can find your PR number on your COPR/ PR Card. (9 or 12 digit) 你可以在加拿大移民部(IRCC)給您的PR確認信/楓葉卡上找到您的 PR 號碼。
UCI number*
You can find your UCI number on letters sent by IRCC. 你可以在加拿大移民部(IRCC)給您的信上找到您的 UCI 號碼。
清晰楓葉卡正面清晰照片 Clear image of PR card *

Cancelof
上載難民身分證明文件 Upload refugee status documentation*

Cancelof
上載身分證明文件 Upload Status documentation*

Cancelof

Information for 4th participant
Legal Name (English)*

Legal First Name 名字 Legal Last Name 姓氏
Preferred name(English)
暱稱
Birthday 生日*

YearMonthDay
Date
Phone Number 聯絡電話*
Please enter a valid phone number.
Email 電郵*
example@example.com
Gender 性別*

Male 男Female 女Other 其他
List Current & Chronic Illnesses 列明現時或長期病患*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
List Allergies列明致敏原*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
Emergency Contact Person緊急聯絡人名字*
Relationship with registrant 與登記人關係*
Emergency Contact Number 緊急聯絡電話號碼*
Immigration Status in Canada 在加拿大的身份*

I am a Canadian Permanent Resident. 我是加拿大永久居民(PR)I am a Convention Refugee.我是公約難民I am Live-in Caregiver 我是住家保姆I am holding Visa Student 我持有學生簽證I am holding Work Permit 我持有工作簽證
PR Card Number 楓葉卡卡號*
You can find your PR number on your COPR/ PR Card. (9 or 12 digit) 你可以在加拿大移民部(IRCC)給您的PR確認信/楓葉卡上找到您的 PR 號碼。
UCI number*
You can find your UCI number on letters sent by IRCC. 你可以在加拿大移民部(IRCC)給您的信上找到您的 UCI 號碼。
清晰楓葉卡正面清晰照片 Clear image of PR card *

Cancelof
上載難民身分證明文件 Upload refugee status documentation*

Cancelof
上載身分證明文件 Upload Status documentation*

Cancelof

Information for 3rd participant
Legal Name (English)*

Legal First Name 名字 Legal Last Name 姓氏
Preferred name(English)
暱稱
Birthday 生日*

YearMonthDay
Date
Phone Number 聯絡電話*
Please enter a valid phone number.
Email 電郵*
example@example.com
Gender 性別*

Male 男Female 女Other 其他
List Current & Chronic Illnesses 列明現時或長期病患*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
List Allergies列明致敏原*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
Emergency Contact Person緊急聯絡人名字*
Relationship with registrant 與登記人關係*
Emergency Contact Number 緊急聯絡電話號碼*
Immigration Status in Canada 在加拿大的身份*

I am a Canadian Permanent Resident. 我是加拿大永久居民(PR)I am a Convention Refugee.我是公約難民I am Live-in Caregiver 我是住家保姆I am holding Visa Student 我持有學生簽證I am holding Work Permit 我持有工作簽證
PR Card Number 楓葉卡卡號*
You can find your PR number on your COPR/ PR Card. (9 or 12 digit) 你可以在加拿大移民部(IRCC)給您的PR確認信/楓葉卡上找到您的 PR 號碼。
UCI number*
You can find your UCI number on letters sent by IRCC. 你可以在加拿大移民部(IRCC)給您的信上找到您的 UCI 號碼。
清晰楓葉卡正面清晰照片 Clear image of PR card *

Cancelof
上載難民身分證明文件 Upload refugee status documentation*

Cancelof
上載身分證明文件 Upload Status documentation*

Cancelof

Information for 2nd participant
Legal Name (English)*

Legal First Name 名字 Legal Last Name 姓氏
Preferred name(English)
暱稱
Birthday 生日*

YearMonthDay
Date
Phone Number 聯絡電話*
Please enter a valid phone number.
Email 電郵*
example@example.com
Gender 性別*

Male 男Female 女Other 其他
List Current & Chronic Illnesses 列明現時或長期病患*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
List Allergies列明致敏原*
If not applicable, please fill N/A. 如不適用，請寫上N/A。
Emergency Contact Person緊急聯絡人名字*
Relationship with registrant 與登記人關係*
Emergency Contact Number 緊急聯絡電話號碼*
Immigration Status in Canada 在加拿大的身份*

I am a Canadian Permanent Resident. 我是加拿大永久居民(PR)I am a Convention Refugee.我是公約難民I am Live-in Caregiver 我是住家保姆I am holding Visa Student 我持有學生簽證I am holding Work Permit 我持有工作簽證
PR Card Number 楓葉卡卡號*
You can find your PR number on your COPR/ PR Card. (9 or 12 digit) 你可以在加拿大移民部(IRCC)給您的PR確認信/楓葉卡上找到您的 PR 號碼。
UCI number*
You can find your UCI number on letters sent by IRCC. 你可以在加拿大移民部(IRCC)給您的信上找到您的 UCI 號碼。
清晰楓葉卡正面清晰照片 Clear image of PR card *

Cancelof
上載難民身分證明文件 Upload refugee status documentation*

Cancelof
上載身分證明文件 Upload Status documentation*

Cancelof

Consent 同意
I hereby acknowledge the following in relation to my participation in services provided by Community Family Services of Ontario (CFSO). 本人特此確認，本人參加由家和提供的服務時須遵守以下條款：*

I ACKNOWLEDGE HAVING READ, UNDERSTOOD AND AGREED to the Release of liability, Waiver of all possible claims, Assumption of risks, and Service consent for myself and every participant in my family/group joining me to the chosen venue as indicated in this form.本人確認已閱讀、理解並同意上述的《免責、放棄任何索償、風險承擔聲明及服務同意書》，以及對本人及攜同的每位參加者的風險承擔。
Consent 同意 -- I agree to be contacted by e-mail and phone call 我同意工作人員將會通過電郵及電話聯繫我。*

Agree 同意Please contact me by E-mail ONLY 我同意工作人員只通過電郵聯繫我。
I agree to be photographed, video-recorded and voice-recorded during the event for possible future use for CFSO publications, internet, and other print media and electronic media. 本人同意授權予家和在本活動中進行拍攝、錄影及錄音，以及同意授權相片及影像用於其刊物、通訊、及其他印刷媒體、電子媒體及互聯網。*

Agree 同意Disagree 不同意
Should be Empty:

(Template)2024-07-27 Niagara Trip & Outlet 尼加拉瓜及Outlet一日遊

Pre-service needs assessment 服務前需要評估

Pre-service needs assessment 服務前需要評估

Pre-service needs assessment for employment services 就業服務：服務前需要評估

Information for 5th participant

Information for 4th participant

Information for 3rd participant

Information for 2nd participant

Consent 同意