Settlement & Family Services
Mandarin Parenting Program 国语育儿服务项目
2025-2026 Mandarin Parenting Program Registration Form 《国语育儿服务项目》注册表
Date 填写日期
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-
Year
-
Month
Day
年/月/日
Personal Information
个人信息
1. Name 姓名
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名字 Legal First Name
姓氏 Last Name
2. Tel. / Cell Phone 电话号码
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Please enter a valid phone number.
3. Address地址
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No.
Street/ Ave
City
Province
Postal code
4. Email 邮箱
*
example@example.com
5. Age Range 年龄范围
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under 19
19 – 24
25 – 34
35 – 44
45 – 54
55-64
over 65
6. Gender 性別
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Male 男
Female 女
Other 其它
7. Country of Origin 原居地
*
Please enter your country of origin
8. Native Language 母语
*
9. Immigration Status 移民身分
*
Please Select
永久居民 Permanent Resident
受保护人士 Protected Person
住家保姆 Live-In Caregiver
公约难民 Convention Refugee
加拿大公民 Citizen
其它 Other
Please choose an option
10. Immigration Category 移民类别
*
Please Select
Business 企业投资
Canadian Experience Class 加拿大经验类
Family Class 家属担保移民
Federal Skilled Worker 联邦技术移民
Federal Skilled Trades Program 联邦技工移民
Live-in Caregiver 住家保姆
Provincial Nominee 省提名移民
Other 其他
Refugee Class: Government-Assisted Refugee 难民类別-政府援助
Refugee Class: Privately - Sponsored Refugee 难民类別-私人资助
Other Refugee Class 其他难民类別
Other Humanitarian & Compassionate Class 其他人道主义和同情类
11. Immigration / Government-Issued ID 移民部颁发的身份证号码ID #( Fill in if applicable, 适用者填写)
PR卡号/ FOSS/GCMS Client ID, 驾照号码 /Driver's license number, Temporary Resident, Minister’s Permit Number, IMM5292, IMM5509, IMM1000
12. Landing date 登陆日期( Fill in if applicable,适用者填写)
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Year
-
Month
Day
13. Education 教育程度 (Optional 可选填)
Please Select
None 無
Elementary 小学
Secondary 中学
Certificate/ Diploma 证书/文凭
Bachelor 大学
Master 硕士
PhD 博士
14. 小孩人数
*
Please Select
1
2
3
4
15-A. First Child
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First Name
Last Name
Gender性別
Birth year 出生年
15-B. Second Child
First Name
Last Name
Gender性別
Birth year 出生年
15-C. Third Child
First Nema
Last Name
Gender性別
Birth year 出生年
15-D. Fourth Child
First Nema
Last Name
Gender性別
Birth year 出生年
16. 我要参加"国语家长小组" I want to join the "Mandarin Parenting Support Group"
*
是，请发送Zoom Link 给我
不是
17. 我需要社区育儿资源和信息.I need community parenting resources and information.
*
是，我需要社区育儿资源和信息
不，我不需要
18. 我需要下列一对一咨询服务(可复选) I need the following one-on-one consultation services.
育儿咨询:身体发展和日常照顾(动作发展、饮食、睡眠...)
育儿咨询:沟通/说话/语言发展
育儿咨询:社交情绪发展(发脾气、哭闹、打人、唱反调、友伴冲突...)
儿童心理健康咨询(焦虑、过动或过静、重复的行为、缺乏眼神对视..)
儿童照顾者心理健康咨询
其他咨询(社区托儿服务资源、儿童福利或托儿津贴申请、移民安頓服务...)
19. 如果您需要咨询服务， 请描述您的疑虑或问题。 If you need consultation services, please describe your concerns or questions.
20. 您从何得知我们的服务项目? Where did you hear about our service?
电邮
朋友/其他家长
社交群组
宣传单
其他
Client Informed Consent Form
客户知情同意书
1. Personal information collected and maintained by the S.U.C.C.E.S.S. Settlement& Family Services 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. 中侨移民安顿与家庭项目依据联邦、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。
*
I agree to the above stated use of my personal information. If I have any further questions, I can contact the Manager in charge of this service. 我同意上述关于个人信息的使用,如果我有任何问题，可以联系负责相关服务的经理
2. 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 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职员披露我的信息
*
I give consent 我同意
I do not give consent 我不同意
3. I would like to be contacted by Settlement & Family Services staff to receive online, email or phone services and learn about upcoming Family Services 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. 我同意移民安顿与家庭项目工作人员与我联系，以接受在线，电邮或电话服务，并同意接收家庭服務讲座、课程或为新移民组织的活动信息。如不再希望中侨互助会职员联系我，可随时要求从中侨互助会电邮名单中移除我的电邮
*
I give consent 我同意
I do not give consent 我不同意
Print Name 正楷姓名
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签名
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