Thank you for using our online application form for

2026 Youth Camping Adventure Registration Form

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.
A red (*) signifies the field is required and must be filled out to move on to the next page and/or complete registration.
Please note that online registration forms are securely processed by Authorize.net.

PROGRAM

Come with us on an outdoor adventure as we camp in the Presidio at the Rob Hill Camping Grounds! Students will learn the essentials of camping through hands-on experience, connect with nature, and build friendships while creating lasting memories. Throughout the trip, students will take part in team-building activities, outdoor games, and guided exploration in a safe and supportive environment. This experience will help students grow, develop practical skills, and unplug from daily routines while enjoying the outdoors together.

LOCATION

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

Camping: Rob Hill Campground at 1475 Central Magazine Rd, San Francisco, CA 94129

ENROLLMENT

Open to All Grades 9-12 high school students

PROGRAM DATES & TIMES

April 01, 2026 - April 03, 2026; Wed to Fri

Check in at April 1st 10:00 AM and Check out April 03 01:00 PM

PROGRAM FEE

$100

please contact Cameron House staff to apply for financial aid.

Application Deadline

Please note that the registration deadline is Wednesday, March 18, 2026.

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

Page 2 of 6

ENROLLMENT INFORMATION / 報名資料

Minor's First Name / 學生名字

Middle Name/Initial (optional) / 中間名字

Minor's Last Name / 學生姓氏

Grade 年級

MINOR GENERAL INFORMATION / 學生資料

Birthdate / 出生日期

MM/DD/YYYY

T-Shirt Size / T 恤尺寸

Gender / 性別

Gender Preference / 個人選擇

Home Phone / 家庭電話

Minor's Cell Phone / 學生手機

Minor's Personal Email / 學生個人電郵地址

SCHOOL

My child attends a school that is / 我的小孩入讀:

part of the San Francisco Unified School District (SFUSD) / 三藩市校區其中一所學校part of a different school district / 其它校區其中一所學校

SFUSD School / 學校

School Name / 學校

SFUSD HO# / 校區學生證號碼

PROGRAM FEE TOTAL

Discounts are available. Should the Registration Fee Amount listed above pose a financial hardship for your family, you may apply for a discount. / 設有減費申請，若有需要，可以進行申請。

Would you like to apply for a needs-based discount? / 是否申請減費?

Yes / 是No / 否

DROP-OFF/PICK-UP INFORMATION / 接送孩子方式詳情

Minor Release Consent / 接送學生同意書

Picked Up By: Primary Name / 首要接學生人仕

Primary Pick-Up Relation to Minor / 關係

Primary Pick-Up Phone / 電話號碼

Picked Up By: Alternate / 次要接學生回家人仕

Alt. Pick-Up Relation to Minor / 關係

Alternate Pick-Up Phone / 電話號碼

Additional Pick-Up Information / 其它接學生回家資料

Page 3 of 6

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舉例.

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.

Page 4 of 6

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。

Page 5 of 6

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舉例

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舉例

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。

Page 6 of 6

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。

Choose the program you enroll:
請選擇您想讓孩子參加的活動：

Youth Adventure Camp

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 "2026 Youth Camping Adventure” indicated on check.

支票抬頭：DONALDINA CAMERON HOUSE 並備註學生姓名、年級及“2026 Youth Camping Adventure”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: Camping Adventure

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

金美倫堂

920

沙加緬度街 三藩市

CA 94108

注: 青年戶外露營

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。

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