April Workshop / Fire Safety and Fire Prevention- New Registration Form

S.U.C.C.E.S.S. Immigrant Settlement & Integration Program Workshop Registration Form

S.U.C.C.E.S.S. 中侨移民安顿与融入项目讲座/活动报名表
Please select the workshop(s) you would like to attend.

请选择您想参加的讲座/活动
Fire Safety and Fire Prevention

消防安全及火灾预防须知
Date/ 日期 :

2024 年 11 月 20 日 (星期三) / November 20th, 2024 (Wednesday)
Time/ 时间 :

10:00 – 11:30AM / 上午10:00 – 11:30
Venue/ 参与方式:

地址: 现场- 恒基2楼办公室/In-person at Henderson Place office Address: #2058-1163 Pinetree Way, Coquitlam
Workshop information*

I would like to attend. 我想参加

S.U.C.C.E.S.S. Immigrant Settlement & Integration Program (ISIP) is funded by Immigration, Refugees and Citizenship Canada (IRCC). The ISIP acknowledges the privacy of its clients. Information provided for the program is confidential and retained in a secure and protected environment. Please fill out the online registration form below to register for the program/workshop. Our staff will contact you prior to the program to validate your information and/or email you the link to join the group activity. The purpose of collecting your information is to better understand newcomers' needs and we use this information to better plan and manage our program and the services provided to you. So, your information helps us ensure that the services fit your needs. Eligible Participants: Permanent Residents, Protected Persons, Convention Refugees and Live-in Caregivers. Please have your Permanent Resident Card (PR Card), IRCC letter or official landing documents information available when we contact you. Thank you.Founded in 1973, S.U.C.C.E.S.S. is one of the largest social service agencies in Canada. S.U.C.C.E.S.S. offers a wide range of programs and services that promote the belonging, wellness, and independence of people in all stages of their Canadian journey. Please visit S.U.C.C.E.S.S. website www.successbc.ca for programs and services. S.U.C.C.E.S.S. 中侨移民安顿与融入项目（ISIP）是由加拿大移民、难民和公民事务部（IRCC）资助。这项目确保其客户的隐私。为这项目提供的信息是保密的，并保存在安全和受保护的环境中。请填写以下讲座/活动报名表格。我们的工作人员将在讲座/活动开始之前与您联系，以核对您的信息和/或通过电子邮件向您发送加入讲座/活动的链接。收集您的信息的目的是为了更好的了解新移民的需求，我们使用这些信息来更好的规划我们的讲座/活动以及向您提供的服务。因此，您的信息可帮助我们确保服务项目是符合您的需求。我们服务的对象为永久居民、受保护人士、公约难民和住家保姆。我们与您联系时，请准备好永久居民卡（PR卡）、IRCC信函或正式登陆文件信息。谢谢。S.U.C.C.E.S.S. 成立于1973年，是加拿大最大的社会服务机构之一。S.U.C.C.E.S.S. 提供广泛的项目和服务，促进人们在加拿大生活的各个阶段的归属感、健康和独立性。请访问 S.U.C.C.E.S.S. 网站 www.successbc.ca 了解项目和服务。
Have you received services from S.U.C.C.E.S.S Tri-Cities ISIP before? 您是否在S.U.C.C.E.S.S.中侨三联市移民安顿与融入项目（ISIP）接受过服务？*

Yes 是No 否Not sure 不確定

Please contact our office at North Road Office 604-936-5900 or Henderson Mall Office 604-468-6000 if you have any concerns or questions to fill this online registration form.

如果您在填写此在线报名表时有任何疑虑或问题，请联系我们的办公室：North Road 办公室 604-936-5900 或 Henderson Mall 办公室 604-468-6000。
Legal Name 姓名*

First Name 名字Last Name 姓氏
Email 电子邮件*
example@example.com
Phone Number 电话号码*
Please enter a valid phone number.
Date of Birth 出生日期*

MonthDayYear
Date
Immigration Status 移民类别*
Personal information collected and maintained by the S.U.C.C.E.S.S. Immigrant Settlement & Integration Program is subject to the provisions of the applicable federal, provincial or territorial privacy and access to information legislation or the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Personal Information Protection Act (PIPA). Therefore, information shared in-person, by phone, email, or online will be kept confidential in accordance with this legislation and will be used only to assist staff in providing service, determining service eligibility and generate anonymous statistics. Confidentiality of the information can only be breached when: required by law or by an order of court; there is reasonable ground to believe that such release will prevent harm; it is necessary to disclose the information to the personnel of S.U.C.C.E.S.S. or accreditation agencies that are authorized to receive such information in the course of their duties. All records are confidential and retained in a secure and protected environment. S.U.C.C.E.S.S. is required to record information pertaining to personal and service information on a federal Immigration, Refugees and Citizenship Canada database that monitors service outcomes. /S.U.C.C.E.S.S.中侨移民安顿与融入项目依据联邦、省或地区政府的隐私和信息获取立法或个人信息保护和电子文件法(PIPEDA)及个人信息保护法（PIPA）的适用法规收集和保管个人信息。因此，通过面对面、电话、电邮或在线提供的信息将依法予以保密，所收集的信息仅用于帮助工作人员在提供服务、确认服务资格及匿名数据统计时使用。信息保密性只有在以下情况不受保护：根据法律要求或在法院颁令下；有合理理由相信披露信息能预防伤害；有必要披露信息给获准在履职过程中接受这些信息的中侨互助会或认证机构职员。所有纪录予以保密并储存在有安全保障的环境中。依据规定，中侨互助会需要在加拿大联邦移民、难民及公民部数据库中纪录客户个人及服务信息，以便追综进服务成效。*

I agree to above stated use of my personal information. 我同意上述使用我的個人資訊。
If I require service (e.g., workshops, webinars, activities) in another ISIP region (Burnaby/New-Westminster, Richmond, Surrey/Fraser Valley, Tri-Cities, Vancouver, & Fort St. John), I agree to give consent to ISIP staff to release my information to the ISIP staff who will serve me in that region./如果我需要另一区域（本纳比/新西敏，列治文，素里/菲沙河谷，三联市，温哥华，和圣约翰堡）移民安顿与融入项目服务（例如讲座、在线研讨会、活动等），我同意向该区域为我提供服务的移民安顿与融入项目工作人员披露我的信息*

I give consent. 我同意I do not give consent. 我不同意
I would like to be contacted by Immigrant Settlement and Integration Program (ISIP) staff to receive online, email or phone services and learn about upcoming settlement workshops, courses, or events for newcomers. If I no longer wish to be contacted by S.U.C.C.E.S.S. staff, I may request to be removed from any S.U.C.C.E.S.S. e-mail lists at any time./ 我同意移民安顿与融入项目工作人员与我联系，以接受在线，电邮或电话服务，并同意接收移民安顿讲座、课程或为新移民组织的活动信息。如不再希望中侨工作人员联系我，可随时要求从中侨电邮名单中移除我的电邮。*

I give consent. 我同意not give consent. 我不同意

S.U.C.C.E.S.S. Immigrant Settlement & Integration Program Workshop Registration Form

Please select the workshop(s) you would like to attend.

Fire Safety and Fire Prevention

Date/ 日期 :

Time/ 时间 :

Venue/ 参与方式:

Please contact our office at North Road Office 604-936-5900 or Henderson Mall Office 604-468-6000 if you have any concerns or questions to fill this online registration form.

Please contact our office at North Road Office 604-936-5900 or Henderson Mall Office 604-468-6000 if you have any concerns or questions to fill this online registration form.