See instructions in Chinese / 於填寫資料之前，請詳閲中文指引

Thank you for using our online application form for

Dragon and Lion Dance Class - 2025 - 26

2025/26 - 舞龍/舞獅班

Please review all of the following information before beginning.

ONLINE FORM INSTRUCTIONS

This form will only accept English responses. Chinese translations are provided for reference only.

If you need to take a break or need to get more information before you can finish, please use the "Save Your Progress" feature and come back at a later time to complete your child's registration. Saving your progress will require an e-mail address and a password of your choosing.
After submission, you will receive an email confirmation of your child enrollment.

PROGRAM

The Dragon and Lion Dance Class is part of Cameron House’s Heritage School* and is being offered to any uprising 6th through 12th graders. Join our Dragon Dance class to master movement while building teamwork, confidence, responsibility, communication, and leadership skills. Experience the art and culture of this vibrant tradition as you grow both personally and creatively!

*Cameron House's Bilingual Youth Program (BYP) Heritage School is exempt from child care licensure. Attendance does not satisfy California's compulsory education requirements pursuant to Section 48200. (Added by Stats. 2010, Ch. 286, Sec. 1. (SB 1116) Effective September 24, 2010.)

LOCATION

Cameron House is located at 920 Sacramento Street, San Francisco, CA 94108

ENROLLMENT

Open to SFUSD students who are rising to Middle/High School in Fall 2025 and Spring 2026.

PROGRAM DATES & TIMES

Fall: Aug 19, 2025 - Dec 18, 2025; Tue & Thurs 4:30PM - 6PM

Spring: Jan 6, 2026 - Jun 2, 2026; Tue & Thurs 4:30PM - 6PM

PROGRAM FEE

$100/SEMESTER ($200 total for both semesters)

ONE TIME payment of $125 for NEW student uniform fee

Attendance Expectations:

Project Sign-Up Participants should sign up for a project using the Google Sheet at least one week in advance to make sure you don’t miss out on materials and projects.

請詳細閱讀以下資料

填寫申請表格須知

此申請表格內容以英文作準，中文翻譯只作參考
假如閣下需要停頓休息或搜集相關資料，請按「Save Your Progress」然後可以再進行填報程序。此行動需要閣下的電郵地址及密碼
申請表被提交後，閣下將會收到電郵通知進確認報名

活動

龍舞獅課是金美倫堂傳承學校* 的一部分，適用於所有 6 至 12 年級的學生。加入我們的龍舞課程，在掌握舞步的同時培養團隊合作、自信、責任感、溝通和領導能力。體驗這充滿活力的傳統藝術和文化，同時提升您的個人和創造力！

金美倫堂傳承學校無需持有孩童護理牌照，也無須遵行加州強制教育條例

條文見於Section 48200. (Added by Stats. 2010, Ch. 286, Sec. 1. (SB 1116) Effective September 24, 2010.)

活動地點

金美倫堂（920 Sacramento Street, San Francisco, CA 94108)

報名

課後班公開接受三藩市校區於秋季入讀6至12年級學生報名

報名資格

活動開放予三藩市校區將要在今年秋季晉升六年級至十二年級的學生報名。

活動日期、時間

2025年8月19日至2025年12月18日; 週二同週四下午 4:30 至 6:00

2026年1月6日至2026年6月2日; 週二同週四下午 4:30 至 6:00

活動費用

每學期費用$100 （兩個學期春季+秋季總共$200）

新學生需支付一次性125美元的製服費

學生出席準則

項目簽到：學生至少需要提前一週使用Google Sheet 報名參加項目，以確保不會錯過項目和準備材料。

I have read and understand the instructions and information listed above. / 本人已詳閲並明白以上指引及資料

Yes / 是的

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ADDRESS / 居住地址

When inputting the address, please do not type Ave., St., etc. into the "Primary Street Name & Number" field. We request that you use the "Street Type" field to complete your address.
請填寫居住地址方式如以下擧例.

For example, if you live at 920 Sacramento St., you would:

- Type "920 Sacramento" in the Primary Street Name & Number field

- Select "St" in the Street Type field

Primary Street Name & Number / 門牌號碼及街名

Example: 920 Sacramento

Street Type

Other Street Type

Apartment #

Primary City / 城市

Primary State/Province / 州名

Primary Zip/Postal Code / 郵區號碼

DEMOGRAPHIC INFORMATION / 學生家庭背境資料

請回答以下問題為相關家庭背境的資料統計

Please select the option that best represents your child's race / 學生種族，請選擇一項:

Please select the option that best represents your child's ethnicity / 學生種族，請選擇一項:

Please use this space to specify your child's race/ethnicity:

Please select the option that best describes your child's housing status. / 居住狀況, 請選擇一項

Please select the option that best represents your child's home language. / 在家中常使用的語言

Please specify your child's home language.

Please select the number of people in your family. A family is defined as all persons living in the same household who are related by birth, adoption, marriage, or domestic partnership. / 同住家人數目

Please select the income range that best fits your family's annual income / 家庭全年總收入.

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MINOR'S MEDICAL/EDUCATIONAL HISTORY / 未成年人仕醫療/教育紀錄

Please list the name, dosage and purpose of medications currently being taken by Minor, as well as any other medical information that would be helpful in our work with your Minor. If none, please enter "None". / 請詳細列明未成年人仕需要服用藥物名稱、劑量及醫療用途，並同時列明未成年人仕其它醫療資料，以便不時之需。如沒有，請填寫 None。

Please describe any other special considerations regarding Minor, including all allergies, dietary restrictions, activity limitations, behavioral issues, recent trauma, or any other concerns. If none, please enter "None". / 請詳細列明未成年人仕其它特別需要，例如敏感、食物特殊反應，行動上的不便及限制、行為問題及其它必須關注的狀況。如沒有，請填寫 None。

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PRIMARY PARENT/ LEGAL GUARDIAN INFORMATION / 家長及合法監護人

Parent/Guardian 1 First Name / 家長名字

Parent/Guardian 1 Last Name / 家長姓氏

Parent/Guardian 1 Primary Phone / 主要聯絡電話號碼

Parent / Guardian 1 Primary Phone Type

Parent/Guardian 1 Alternate Phone / 次要聯絡電話號碼

Parent / Guardian 1 Alternate Phone Type

Please select a different value than "Parent/Guardian 1 Primary Phone Type".

Parent/Guardian 1 E-mail / 電郵地址

A confirmation e-mail will be sent to this e-mail address / 所有電郵通訊將會傳送此地址

Use a different address than listed for child / 家長其它居住地址.

Yes / 是的

When inputting the address, please do not type Ave., St., etc. into the "Primary Street Name & Number" field. We request that you use the "Street Type" field to complete your address.
請填寫居住地址方式如以下擧例

For example, if you live at 920 Sacramento St., you would:

- Type "920 Sacramento" in the Primary Street Name & Number field

- Select "St" in the Street Type field

Street Name & Number / 門牌號碼及街名

Example: 920 Sacramento

Street Type

Other Street Type

Apartment #

City / 城市

State/Province / 州名

Zip/Postal Code / 郵區號碼

SECONDARY PARENT/LEGAL GUARDIAN INFORMATION / 其它家長及合法監護人

Parent/Guardian 2 First Name / 家長名字

Parent/Guardian 2 Last Name / 家長姓氏

Parent/Guardian 2 Primary Phone / 主要聯絡電話號碼

Parent / Guardian 2 Primary Phone Type

Parent/Guardian 2 Alternate Phone / 次要聯絡電話號碼

Parent / Guardian 2 Alternate Phone Type

Please select a different value than "Parent/Guardian 2 Primary Phone Type"

Parent/Guardian 2 E-mail / 電郵地址

Use a different address than listed for child / 家長其它居住地址.

Yes / 是的

When inputting the address, please do not type Ave., St., etc. into the "Primary Street Name & Number" field. We request that you use the "Street Type" field to complete your address.
請填寫居住地址方式如以下擧例

For example, if you live at 920 Sacramento St., you would:

- Type "920 Sacramento" in the Primary Street Name & Number field

- Select "St" in the Street Type field

Street Name & Number / 門牌號碼及街名

Example: 920 Sacramento

Street Type

Other Street Type

Apartment #

City / 城市

State/Province / 州名

Zip/Postal Code / 郵區號碼

EMERGENCY CONTACT / 緊急聯繫人

The Emergency Contact must be at least 18 years of age, and someone other than the parent(s)/legal guardian(s) listed on the previous page. The role of the Emergency Contact is as follows:

1) Next person to contact in the event of an emergency or disaster when the parent/guardian cannot be reached

2) Pre-approved person(s) to whom Minor will be released in an emergency or disaster situation

It is Cameron House's policy that minors will not be released to the care of another minor in an emergency or disaster situation.

緊急聯繫人必須年滿 18 歲，並且是上述學生家長/合法監護人以外的人仕。緊急聯絡人是：

1) 在無法聯絡到家長/監護人的緊急或災難情況下，必須要聯絡的人仕

2) 在緊急或災難情況下，接走學生的人仕

金美倫堂的政策不允許在緊急情況或災難情況下將未成年人交給其他未成年人照顧。

Emergency Contact First Name / 緊急聯絡人名字

Emergency Contact Last Name /緊急聯絡人姓氏

Emergency Contact Relationship to Minor / 與學生關係

Emergency Contact Email / 電郵地址

Emergency Contact Primary Phone / 主要聯絡電話號碼（包括地區號碼及請選擇電話類別）

Emergency Contact Primary Phone Type

Emergency Contact Alternate Phone / 次要聯絡電話號碼（包括地區號碼及請選擇電話類別）

Emergency Contact Alternate Phone Type

Preferred Hospital: Please list the preferred hospital for your child in the event of a medical emergency. Sometimes emergency personnel asks for a preferred hospital. If no preference is listed, emergency personnel may decide. / 首選醫院：請列出您的未成年學生的首選醫院, 如果發生醫療緊急情況, 緊急護理人員需要知道學生首選醫院。否則，緊急護理人員可能会自行決定。

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PROGRAM PAYMENT / 活動費用

Payment (cash, check, or credit card) is required to complete enrollment.

付款時必須連同埴寫妥當的報名表。

Please select which semester you like to enroll in:
請選擇您想讓孩子參加的學期：

Fall Semester 秋季學期 (Aug 19, 2025 - Dec 18, 2025)Spring Semester 春季學期 (Jan 6, 2026 - Jun 2, 2026)Full Year 全年 (Aug 19, 2025 - Jun 2, 2026)

FEE AMOUNT DUE / 活動費用數目

$

Method of Payment / 付款方式:

Credit Card / 信用咭Check / 支票Cash / 現金

Please verify that the "Program Fee Amount" is correct before submitting your credit card information.

呈交信用咭之前請準確肯定：

Checks can be made payable to DONALDINA CAMERON HOUSE with child’s name, grade, and "Dragon Dance Class 2025” indicated on check.

支票抬頭：DONALDINA CAMERON HOUSE 並備註學生姓名、年級及“Dragon Dance Class 2025”於支票。

Bring or mail check payment to: 請親身送到金美倫堂或郵寄至以下地址:

Donaldina Cameron House

920 Sacramento Street

San Francisco, CA 94108

Attention: Youth Enrollment

HOURS: 10:00 AM - 6:00 PM

Bring cash payment to: 若以現金支付，請親身送到金美倫堂

Donaldina Cameron House

920 Sacramento Street

San Francisco, CA 94108

Attention: Youth Enrollment

HOURS: 10:00 AM - 6:00 PM

CREDIT CARD INFORMATION / 信用咭資料

Credit Card Number / 信用咭號碼

Credit Card Expiration Month / 有效月份

Please use format MM (eg. 01 for January)

Credit Card Expiration Year / 有效年份

Please use format YYYY (eg. 2024)

Credit Card CVV/Security Code / 安全號碼

BILLING INFORMATION / 付款人資料

First Name / 名字

Last Name / 姓氏

Email / 電郵地址

Phone / 電話號碼

BILLING ADDRESS / 付款人地址

Billing Street / 街名

Billing City / 城市

Billing State / 州名

Billing Country / 國家

Billing Zip / 郵區號碼

I understand that payment (credit card, check or cash) is required to complete enrollment. / 申請入學表格必須填寫付款方式, 並於報名時即時付交費用。

REVIEW & CONFIRMATION / 審核及確定

By submitting this registration form, I willingly acknowledge that all information entered regarding the minor, the minor's relationships, and the minor's family to be accurate / 本人提交此報名表並確認所有填報資料真實無誤，包括關於本人未成年子女，和本人及家人關係

Click the "Review" button to confirm or edit your responses. At the bottom of the "Review" page, there are 3 buttons:

CONFIRM - To finalize your responses, you MUST click the CONFIRM button. Please do not hit the "Back" or "Refresh" button after hitting confirm. The form can sometimes take a minute to process, so thank you in advance for your patience.

EDIT - To make any changes to your response, please click the EDIT button.

PRINT - If you would like a printed copy of this form, you must click the PRINT button before clicking the CONFIRM button.

NOTE: After review and submission, if you experience a processing error, please save your progress if possible. Staff will look into the error and follow up with you about the issue. Please DO NOT submit the form multiple times.

若需確定或修改，請按”Review”，可選其中一項：

確定：若需確定完成報名，請按”CONFIRM”，並請耐心等候，不要再按鍵盤，可能需時數分鐘

修改：若需修改，請按”EDIT”

打印：若需打印，請於按確定”CONFIRM”前按”PRINT”

備注：

若提交報名表後出現不明狀況，請儲存報名表內容，金美倫堂職員將會作進一步調查，敬請不要多次呈交報名表。

FORMULAS AND HIDDEN FIELDS

Conversion Source

Authnet_Hidden_Fields

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