PDF《义工服务中心 Volunteer Action Centre》

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2 VRP-01 C

16 Jun

2015 义工服务中心 Volunteer Action Centre 义工转介服务 C 机构(单位)登记或重新登记表 Volunteer Referral Programme C Organization (Unit) Registration or Renewal Form 请以正楷填写,以便电脑处理资料.

为方便日后联络及收取登记机构资讯,请提供电邮地址. Please complete the form CLEARLY so as to facilitate computer data processing. For future communications, please provide E-mail address. 机构资料 Agency Details (如属重新登记, 请注明於本局之机构登记编号 Please state your Registration No. in AVS (if any) : ) Agency Name (English) : 机构名称(中文) : Agency Address (English) : 机构地址(中文) : Mailing Address (English) : (if different from the above address) 通讯地址(中文) : (如与上述地址不同) 电话 Tel : 传真 Fax : 电邮 E-mail : 机构网页 Website : 服务地区 District Served : 办公时间 Office Hours : 机构负责人 Person In-charge 姓名 Name (先生 Mr / 女士 Ms) : (English) (中文) 职位 Post Title : (English) (中文) 电话 Tel : 传真 Fax : 电邮 E-mail : 机构联络人 Contact Person 姓名 Name (先生 Mr / 女士 Ms) : (English) (中文) 职位 Post Title : (English) (中文) 电话 Tel : 传真 Fax : 电邮 E-mail : 服务性质 Service Nature (请在合适的格内? Please ? as appropriate) 青少年 Children & Youth 长者 Elderly 家庭及幼儿 Family & Child Care 复康 Rehabilitation 教育 Education 医疗及健康 Medical & Health Care 文化及体育 Culture & Sports 社区服务 Community Service 释囚或戒毒 Rehabilitated Inmate / Drug Abuser 其他(请列明)Others (Please specify) 机构保障个人资料承诺书 Personal Data Protection - Agency Consent Form *本机构同意确保义工局所转介的义工个人资料不被外泄或转移作其他未经义工局允准之用途. I, the undersigned, agree to protect all volunteers' data referred by AVS from being disclosed or transferred for any unrecognized purpose. *声明:我已阅读及明白「义工转介服务登记机构须知」 ,同意及遵守须知,并谨此声明所填报的资料真确无讹. Disclaimer: I, the undersigned, have read and understood the "Note to Organization (Unit)", agreed to and abide by notified, and declare that the information is true and correct. 机构负责人签署 : 机构盖章 : 日期 : Signature of In-charge Agency Chop Date 此栏由本局填写 For office use only 收表单位: 登记机构编号: 收表日期: 最早登记日期: 登记费用: $ 此次登记期: 至 缴费方式: 现金/支票 资料输入日期: 支票号码: 资料输入员: 银行入数日期: 收嗪: 备注: 备注: 经手人: 审批人: Page

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2 VRP-01 C

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2015 个人资料收集: 义务工作发展局可能使用你的个人资料作数治黾巴臣啤⒊锟睢⑹占饧蚧疃乒愕扔猛.倘若你不同意上述安排,请於以下方格内 加上「?」号.如欲查询、更改已递交的个人资料或要求本局停止使用你的个人资料,请电邮至avs@avs.org.hk或致电2527 3825与本局职员 联络. 本人不同意义务工作发展局使用我的个人资料作上述用途. Collection of Personal Information AVS may use your personal data for providing Agency news, issuing receipt, service referral, compiling statistics and data analysis, fundraising appeal, collecting feedback or activity promotion. Please "?" in the box below if you object to the above arrangement. For correction of, access to or cessation to use your personal data, please contact us at

2527 3825 or by email avs@avs.org.hk. ??I object to the proposed use of my personal data for the above-mentioned purposes. 机构登记资格及手续: 凡政府部门、政府认可之慈善团体或非牟利服务机构,均可申请成为本局登记机构.申请者只须递交以下文件及费用予本局义工服务中心 办理,经本局审核后便可成为义工转介服务之登记机构,向本局徵求义工协助推行服务.登记机构将获发「机构登记证书」及「登记机构 手册」 .登记有效期为两年,期满后须再续. (1) 填妥之 [义工转介服务 C 机构(单位)登记或重新登记表] (即此表格) (2) 机构(单位)简介一份 (如有) (3) 登记费港币

200 元 备注: ? 视乎情况,本局可能要求登记机构提供政府认可之慈善团体或非牟利服务机构的有关证明文件,以及社团注册证明文件副本. ? 为方便本局与登记机构(单位)之联系及行政程序,如机构属下之不同单位或分区单位需使用本局之义工转介服务,均须个别登记. ? 假若义务工作发展局不接纳此项申请,义务工作发展局将发还已缴费用. Eligibility and Procedures for Registration: All Government Departments, recognized non-profit organizations or charitable organizations are welcome to get registered in AVS and recruit volunteers through our Volunteer Referral Programme. Successful applicants would be provided the Certificate of Registration and Organization Handbook. Registration is valid for

2 years and renewable upon expiry. The following documents should be submitted to the Volunteer Action Centre of Agency for Volunteer Service. (1) completed [Volunteer Referral Programme C Organization(Unit) Registration or Renewal Form] (this form) (2) an introductory pamphlet of organization(unit) (if any) (3) registration fee of HK$200 Remarks: ? Supporting documents of being a non-profit organization and certificate of registration of a society may be required. ? To facilitate our future communications and administration procedure of our Agency, different units of an organization should register individually. ? If this application is not accepted by the Agency for Volunteer Service, the registration fee will be refunded to the applicant. 缴款方式 Method of Payment: 1. 支票 Cheque: 支票须划线,抬头请写『义务工作发展局』 .寄回或交回义工服务中心. Crossed cheque made payable to the "Agency for Volunteer Service" should be sent to the Volunteer Action Centre. 支票号码 Cheque No.: 2. 现金 Cash: 请直接交回本局义工服务中心,切勿邮寄现金. Cash should be paid to the Volunteer Action Centre. Please do not mail cash. 义务工作发展局 Agency for Volunteer Service 义工服务中心 Volunteer Action Centre 香港西营盘西源里六号 G/F and 1/F, Yuen Fai Court 源辉阁地下及一楼

6 Sai Yuen Lane, Sai Ying Pun, HK 电话 Tel:(852) 2546-0694 传真 Fax:(852) 2559-5142 电邮 E-mail:vac@avs.org.hk 网址 Website:http://www.avs.org.hk