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113年臺中榮民總醫院暑期高中學生志願服務報名表
活動日期:2024-06-07
志工相關
活動說明
本隊於暑假期間提供短期志願服務機會,在各服務組別執行服務,帶領青少年體驗服務人群、社會參與及社會服務之經驗,藉以建立公民社會風氣,推廣志願服務理念。
活動官網
http://www.vghtc.gov.tw
活動地點資訊
地點:臺中市西屯區臺灣大道4段1650號 (臺中榮民總醫院)
顯示地圖資訊
30
BeClass 線上報名系統
113年臺中榮民總醫院暑期高中學生志願服務報名表
(2024-06-07)
(報名截止)
※
姓名
※
性別
男
女
生日
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31
※
Email
行動電話
市話
(
)
#
※
地址
縣/市
基隆市
台北市
新北市
桃園市
新竹市
新竹縣
苗栗縣
台中市
彰化縣
南投縣
雲林縣
嘉義市
嘉義縣
台南市
高雄市
屏東縣
台東縣
花蓮縣
宜蘭縣
澎湖縣
金門縣
連江縣
其它
區域
※
身分證字號
※
我要報名服務梯次
每人僅可勾選一項
第一梯7月15日(一)至7月19日(五)8時至17時
(總量 20)
第二梯7月22日(一)至7月26日(五)8時至17時
(總量 20)
第三梯7月29日(一)至8月2日(五)8時至17時
(總量 20)
第四梯8月5日(一)至8月9日(五)8時至17時
(總量 20)
假日服務7月14日(日)至9月8日每週日8時至12時
(總量 10)
※
現就讀學校名稱
※
就讀科系名稱
※
年級
※
英文姓名
為製作英文時數證明,請用英文大寫(與護照相同)書寫
※
家庭成員資料
稱謂
1.
2.
3.
4.
5.
6.
※
家庭成員姓名
姓名
1.
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家庭成員年齡
年齡
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家庭成員職業
職業
1.
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※
健康狀況
疾病症狀(請說明)
良好
其它:
※
監護人姓名
本院服務單位(若非本院員工子女則免填)
院內分機(若非本院員工子女則免填)
※
家長同意書
請監護人簽章後上傳檔案
檔案大小上限:
5,000KB
檔案類型:
圖形(jpg、png、gif)、Word檔、Excel檔、Pdf 檔
※
個人資料使用同意及保密切結書
請報名學生簽章後上傳
檔案大小上限:
5,000KB
檔案類型:
圖形(jpg、png、gif)、Word檔、Excel檔、Pdf 檔
團報資料
§ 請點此處填寫
團體報名
資料
總金額
***
元
(依據人數計費:每人
元)
※目前報名數:30
[
查詢]、[
編修]、[
取消]
※同一承辦人員其他活動報名表
報名截止
報名成功者須於第一天服務報到時繳交: 如果報名資料不實者,則取消報名資格。
□學生證(確認身份後歸還)。
□若屬臺中榮民總醫院正式員工子女學生須出示員工與子女關係證明(確認後歸還)。
□三張1吋大頭照及照片檔案光碟(存檔後歸還)。
□一年內胸部X光檢查報告(影本)。
□不限年限B型肝炎抗原抗體報告(影本)。
□5年內麻疹、德國麻疹抗體陽性報告或15年內完成二劑MMR疫苗接種紀錄(影本)。
志願服務紀錄冊: □有:報到時請繳交□無 :在正式服務須完成志工基礎及特殊教育訓練課程:
請自行上網搜尋「臺北e大」,搜尋「[志願服務]志工基礎教育訓練(6小時版)」(&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;amp;quot;&amp;amp;amp;amp;lt;a href=&amp;amp;amp;amp;quot;&amp;amp;amp;lt;a href=&amp;amp;amp;quot;&amp;amp;lt;a href=&amp;amp;quot;&amp;lt;a href=&amp;quot;&lt;a href=&quot;<a href="
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