2010大華府地區「臺灣文化之旅」友誼競賽
推廣人文藝術的生力軍
2010 Washington Metropolitan Area
"Cultural tour of Taiwan" Competition
Arts and Humanities
報名表
Registration form
參賽隊名稱 Team Name：
(中文 Chinese) ：___________________________(英文 English) ：_________________________
校長姓名Name of Principal (Option):
(中文 Chinese) ：___________________________(英文 English) ：_____________________ 聯絡電話Contact Phone:： Email ：
指導老師姓名Instructor Name：
(中文 Chinese) ：________________________ (英文 English) ：_____________________ 聯絡電話Contact Phone:： Email ：
參賽隊員姓名Team members Name：
1. 隊長 Captain
(中文Chinese) ：_____________________ (英文 English) ：_______________________
出生年月日Date of Birth： 聯絡電話Contact Phone： Email ：
2. (中文 Chinese) ：_____________________ _ (英文English) ：_______________________
出生年月日Date of Birth：
3. (中文Chinese) ：_______________________ (英文English)_______________________
出生年月日Date of Birth：
Page 1
Permission to Use Student Work (同意使用授權書)
1. Grant of Permission (同意無酬使用授權). Please print clearly:
I, , Parent/Guardian(監護人) of , I, , Parent/Guardian(監護人) of , I, , Parent/Guardian(監護人) of ,
hereby give to Chinese Network Educational Seed Teachers' Association (大華府華文網路師資聯誼會) my permission to use the following work (the “Work ”). I hereby authorize the“work ” will be published on Chinese NESTA owned website and related accounts, such as Youtube, without any payment.
2. Certification of Authorship (宣示著作所有權). I am the owner of the copyright to the Work, and the Work is not now subject to any grant or restriction that would prevent its use consistent with this permission. Except as explicitly indicated on the Work, all aspects of the Work are original to me and have not been copied or adapted from other sources.
3. Privacy Release (影像授權). I hereby authorize and consent to the release of student picture, image and video without
student name for Chinese NESTA newsworthy events. This authorization also includes the disclosure of the content of the Work itself and any associated information.
Student Signature:
Parent/Guardian(監護人) Signature:
________________________ Date: ____/___/______
________________________ Date: ____/___/______
________________________ Date: ____/___/______
________________________ Date: ____/___/______
________________________ Date: ____/___/______
________________________ Date: ____/___/______
Page 2
2010大華府地區「臺灣文化之旅」友誼競賽
推廣人文藝術的生力軍
2010 Washington Metropolitan Area
"Cultural tour of Taiwan" Competition
Arts and Humanities
報名表
Registration form
參賽隊名稱 Team Name：
(中文 Chinese) ：___________________________(英文 English) ：_________________________
校長姓名Name of Principal (Option):
(中文 Chinese) ：___________________________(英文 English) ：_____________________ 聯絡電話Contact Phone:： Email ：
指導老師姓名Instructor Name：
(中文 Chinese) ：________________________ (英文 English) ：_____________________ 聯絡電話Contact Phone:： Email ：
參賽隊員姓名Team members Name：
1. 隊長 Captain
(中文Chinese) ：_____________________ (英文 English) ：_______________________
出生年月日Date of Birth： 聯絡電話Contact Phone： Email ：
2. (中文 Chinese) ：_____________________ _ (英文English) ：_______________________
出生年月日Date of Birth：
3. (中文Chinese) ：_______________________ (英文English)_______________________
出生年月日Date of Birth：
Page 1
Permission to Use Student Work (同意使用授權書)
1. Grant of Permission (同意無酬使用授權). Please print clearly:
I, , Parent/Guardian(監護人) of , I, , Parent/Guardian(監護人) of , I, , Parent/Guardian(監護人) of ,
hereby give to Chinese Network Educational Seed Teachers' Association (大華府華文網路師資聯誼會) my permission to use the following work (the “Work ”). I hereby authorize the“work ” will be published on Chinese NESTA owned website and related accounts, such as Youtube, without any payment.
2. Certification of Authorship (宣示著作所有權). I am the owner of the copyright to the Work, and the Work is not now subject to any grant or restriction that would prevent its use consistent with this permission. Except as explicitly indicated on the Work, all aspects of the Work are original to me and have not been copied or adapted from other sources.
3. Privacy Release (影像授權). I hereby authorize and consent to the release of student picture, image and video without
student name for Chinese NESTA newsworthy events. This authorization also includes the disclosure of the content of the Work itself and any associated information.
Student Signature:
Parent/Guardian(監護人) Signature:
________________________ Date: ____/___/______
________________________ Date: ____/___/______
________________________ Date: ____/___/______
________________________ Date: ____/___/______
________________________ Date: ____/___/______
________________________ Date: ____/___/______
Page 2