Mandarin Parenting Program

Settlement & Family Services

Mandarin Parenting Program 国语育儿服务项目
Mandarin Parenting Program Registration Form 《国语育儿服务项目》注册表
Date 填写日期

YearMonthDay
年/月/日
Personal Information

个人信息
1. Name 姓名

名字 Legal First Name姓氏 Last Name
2. Tel. / Cell Phone 电话号码
Please enter a valid phone number.Format: (000) 000-0000.
3. Address地址

No.Street/ AveCityProvincePostal code
4. Email 邮箱
example@example.com
5. Age Range 年龄范围
6. Gender 性別
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 choose an option
10. Immigration Category 移民类别
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)

YearMonthDay
13. Education 教育程度 (Optional 可选填)
14. 小孩人数
15-A. First Child

First NameLast NameGender性別Birth year 出生年
15-B. Second Child

First NameLast NameGender性別Birth year 出生年
15-C. Third Child

First NemaLast NameGender性別Birth year 出生年
15-D. Fourth Child

First NemaLast NameGender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"
17. 我需要社区育儿资源和信息.I need community parenting resources and information.
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.
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?
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。
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
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
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Settlement & Family Services

Mandarin Parenting Program Registration Form 《国语育儿服务项目》注册表

Personal Information

Client Informed Consent Form