Palliative Care and End-of-life Care Webinar registration

舒緩治療、安寧療護和臨終關懷服務導引指南登記表格 Palliative Care and End-of-Life Care Navigation Webinar Registration Form
Legal Name 姓名(English 英)*

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*
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
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: https://cfso.care/zh-hant/faq-items/ircc-flyer-data-collection-tradch/

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

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
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舒緩治療、安寧療護和臨終關懷服務導引指南登記表格 Palliative Care and End-of-Life Care Navigation Webinar Registration Form

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

Consent 同意