lEISURE AND CULTURAL SERVICES DEPARTMENT
						           Application for Recreation and Sports Activities
					               (HOLIDAY cAMPS AND GROUPS ACTIVITIES)	LCS638a(Revised in June 2011)	
	For Office Use	
	Full Rate
_____no.	Concessionary Rate
________ no.	

Activity Code: ______________________  Name of Activity : _____________________________________________________
(For holiday camps, please contact the organizing district offices for the room capacity prior to application)
Particulars of Group ( Please fill in the fields marked with *.  Otherwise, your application will not be entertained.)
*Name of Applicant/Leader : 		*Sex :	  Male	    Female	
(Should be aged 18 or above)	(Should be the same as the one shown on the identity document)											
Chinese Code (If any):																				*Date of Birth :											
	                Day       Month          Year	
*Identity Certificate No.: ________________________________
*Contact Tel. No.: (Day) ___________________    (Night) ____________________    (Mobile) _______________________
Emergency Contact Person :__________________________ Emergency Contact Person’s Tel. No.: _________________________
Occupation: Employed  Housewife  Full-time Student	Retired    Others, please specify__________________

Particulars of Group Members  (Identification documents (original or copies) of all members should be produced during enrolment.  Please include the particulars of the applicant / leader or contact person if he / she is one of the members.)

No.	*Name 
(Should be the same as the one shown on the identity document)	*Identity Certificate Number	*Date of Birth
(D/M/Y)	*Sex	#Occupation	
1.						
2.						
3.						
4.						
5.						
6.						
7.						
8.						
9.						
10.						

Use additional form if the space provided is insufficient.
#	Please indicate your occupation by filling in the following code numbers for respective occupations:  
  	1 = Employed      2 = Housewife      3 = Full-time Student      4 = Retired      5 = Others

Declaration
		I (Applicant/Leader) hereby declare the above information is correct to the best of my/our knowledge.  Member/s aged under 18 already have his/her/their parent/guardian’s consent to participate the above activity, and he/she/they does/do not suffer from any illness that renders him/her/them unfit for the activity.

Signature of Applicant/Leader : ______________________________        Date : ___________________________________

Note:	1.	The originals or copies of all members’ identify documents should be produced upon enrolment for our verification of their eligibility and the charging of appropriate types of fees.	
	2.	For programme entry fees, please refer to the enrolment guide, or programme information sheets.	
	3.	The enrolment fees of all activities do not include meal charges.  Day campers or overnight campers have to pay their own meal charges.	
	4.	The information provided by you will only be used for enrolment of recreation and sports activities organized by the Leisure and Cultural Services Department, future contact purpose and opinion survey.  For correction of or access to personal data collected by means of this form, please contact the staff of the enrolment counter/district.	

Please complete the following address panels.  (Please fill in either Fax No. or Address)

Name   ：	

Fax No. ：	

Address ：	

	

		
Name   ：	

Fax No. ：	

Address ：