2016宁夏夏令营

2016“寻根”夏令营，宁夏营开始报名！报名事项夏令营营期内学习、食宿、交通、参观等全部费用由国务院侨办与宁夏侨办共同承担，其它费用自理（包括：签证费、往返国际机票、往返营地的中国国内交通费、医疗费等）。营员要求是：12-18岁的海外华裔青少年，身体健康，有一定汉语基础和较强生活自理能力。 “新丝路探奇之宁夏营”华盛顿营队的名额有限，将采用先到先报、报满即止的报名政策（将优先考虑西北籍华裔青少年）。请尽快到华盛顿中国西北同乡会网站报名（www.ncaagw.org）。报名时需交报名费（组织管理费）$100，并填写相关表格。有关“新丝路探奇之宁夏营”夏令营的详细信息，请联系沈东泉（614-329-0385, cdbill@gmail.com）、李燕（301-655-1697，ylsan@live.com）。

1、小孩中文姓名 *

2、小孩生日 *

3、小孩年龄 *

只能填数字

4、小孩英文姓名 *

5、小孩性别 *

男

女

6、小孩护照号 *

7、护照颁发国 *

8、小孩手机 *

9、小孩身高 *

10、食物禁忌，重大病史 *

11、家庭成员是否是西北籍或曾经在西北生活、工作或学习过？ Is any family member related to Northerwest China: through either birth, school, work, etc? *

是

否

12、美国住址 (Address in USA) *

13、父姓名（中、英文） *

14、母姓名（中、英文） *

15、父母联系电话 *

16、父母联系Email *

17、国内亲属联系方式 *

18、免责声明：(statement of consent and release of liability) *

I Agree

By checking here, I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL. I am the legal parent or guardian of the child. I fully understands the risks involved in the activities, and fully, voluntarily and freely assume any and all risks. I understand that participant is fully responsible for all his/her activity and any consequence may occur. I acknowledge and agree that POC assume no liability for any accident, illness, injury, loss or damage to personal property or any other consequences arising or resulting directly or indirectly from the participation in the event. I also understand that it is sole parent's responsibility to arrange means to send child to report to camp and pick up the child when the camp is closed.

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