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賽馬會齡活城巿「全城‧長者友善」計劃 2020
Jockey Club Age-friendly City Partnership Scheme 2020

網上申請表格 Online Application Form
請於2020年8月14日(星期五)或之前填妥並遞交以下表格。
Please complete and submit the below application form on or before 14 August 2020 (Friday).

有關「賽馬會齡活城市『全城．長者友善』計劃」之申請指引，請按此瀏覽。
For “Jockey Club Age-friendly City Partnership Scheme – Application Guide”, please click here.

標註*的為必填項目。Fields marked with * are required.

申請人資料 Details of Applicant
請輸入中文/ Please enter Chinese here
請輸入英文/ Please enter English here
註：公司／機構名稱將按所提供的名稱刊登 Note: Name of Company / Organisation will be published as listed above

請輸入中文/ Please enter Chinese here
請輸入英文/ Please enter English here
請輸入中文/ Please enter Chinese here
請輸入英文/ Please enter English here
請輸入八位數字電話號碼/ Please enter 8-digit number
請輸入八位數字傳真號碼/ Please enter 8-digit number
請輸入有效電郵地址/ Please enter a valid email address
註：用於郵寄證書及標籤 (如適用) Note: For the delivery of Scheme’s certificate & stickers if applicable

申請人類別 Type of Applicant *
須選擇最少一項 at least ONE option is needed to be selected

公司／機構行業 Industry of Company / Organisation *
須選擇最少一項 at least ONE option is needed to be selected
第一部份：賽馬會齡活城巿「全城 ‧ 長者友善」計劃標籤
PART I: The Jockey Club Age-friendly City Partnership Scheme Sticker
參與的公司／機構必須在下列八大範疇中其中一個或多個範疇，推出最少一項長者及年齡友善措施／活動、或提供任何長者及年齡友善產品／服務，方可獲得賽馬會齡活城巿「全城 ‧ 長者友善」計劃標籤。請於適當的空格加上“✓”( 可選多於一個 )*，並提供有關詳情*。
(按此了解更多關於世衞確認「長者及年齡友善城市」的八大範疇。)

Participating companies / organisations which have adopted at least ONE age-friendly practice / activity or provide age-friendly product(s) / service(s) under any of the eight domains listed below will be eligible for receiving the Jockey Club Age-friendly City Partnership Scheme Sticker. Please put a “ ✓ ”in the appropriate box(es)* and provide details*.
(Click here to learn more about the eight domains of an age-friendly city identified by WHO.)

須選擇最少一項 at least ONE option is needed to be selected
(例子：採用長者及年齡友善的建築設計及設施 Example: Adopt age-friendly designs for buildings and facilities)
(例子：為長者提供便利、安全及可負擔的交通設施或服務 Example: Provide convenient, safe and affordable transport facilities or services for senior citizens)
(例子：為長者提供可負擔、設計合適和安全的家居設計及維修服務 Example: Provide affordable, well-designed and safe home design and maintenance services for senior citizens)
(例子：舉辦切合長者不同興趣的活動 Example: Organise activities that cater for older people’s diverse interests)
(例子：舉辦跨代共融活動或服務長者的義工活動，或為長者提供優先服務 Example: Organise intergenerational activities or volunteer services to serve the elderly, or provide priority services)
(例子：聘用長者員工或為長者提供再培訓計劃 Example: Provide job opportunities or retraining scheme for senior citizens)
(例子：設立電子平台或課程，協助長者獲得及時資訊、尋找合適服務及加強溝通 Example: Establish digital platforms or classes which allow senior citizens to access timely information, seek suitable services and enhance communication)
(例子：為長者提供多元化、便利、可負擔的醫療和支援服務 Example: Provide a wide range of accessible and affordable health and support services for senior citizens)

所有參與公司及機構的名稱將列於本計劃之網站、所出版之刊物及其他宣傳品內，供公眾參閱。請提供下列資料。
Names of all participating companies and organisations will be listed on the website, publications and other collaterals under the Scheme which will be made available for the public. Please provide below information.

(請提供JPEG／PNG檔案 (最少 300 dpi) Please provide JPEG / PNG file (at least 300 dpi))



請上傳公司/公司標誌； Please upload company / organisation logo
第二部份：特別大獎
PART II: Special Awards
如有意競逐計劃之特別大獎，請填妥以下第二部分之資料。
If you would like to apply for the Special Awards, please fill in the information of PART II.

按此了解更多關於2019年得獎之長者及年齡友善措施。
Click here to learn more about the awarded age-friendly practices in 2019.

請輸入中文/ Please enter Chinese here
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(如尚在進行中，完結日期可留空 Please leave the end date blank if still in progress)


^ 請展示有關長者及年齡友善措施/活動/產品/服務之創意及創新性、對社會的影響、投放的資源及可持續性。Please demonstrate the creativity and innovation, social impact, resources devotion and sustainability of the age-friendly practice / activity / product / service.

如競逐「友善人情大獎」，請分享一個富人情味及於推動長者及年齡友善文化方面具啟發性的故事。For application for Our City’s Story Award, please share the details of a story that has a great impact on promoting an age-friendly culture in Hong Kong.


請提供高解像度JPEG／PNG檔案(1,000 x 1,000像素或以上)，最多5張相片共15MB為限。 Please provide high-res JPEG / PNG file (1,000 x 1,000 pixels or above), Maximum 5 images in 15MB in total.
新增圖片 Add Image

#有關照片將於「賽馬會齡活城巿計劃」Facebook 專頁用作公眾投票，及使用於本計劃之網頁、所出版之刊物及宣傳品內。The photo(s) will be used for public voting on the Jockey Club Age-friendly City Project’s Facebook Page, as well as website, publications and other collaterals under the Scheme.

(如欲遞交額外補充資料，請在此直接上載。最多5個檔案共15MB為限）If you would like to submit other supplementary information, please upload here. Maximum 5 files in 15MB in total)
新增檔案 Add File

條款及細則 Terms and Conditions
  1. 本人／吾等謹此聲明，此項申請所提供的一切資料及有關文件均屬真確無誤及詳盡，而本人／吾等已全面書面披露本人／吾等所知或應合理知悉的所有有關此項申請的相關或重要資料，以供申請之用，亦明白若提供任何失實資料將有可能被取消報名資格。
    I/We declare that all information and supporting documents provided in this application are true, accurate and complete. I/We declare that we have disclosed fully in writing all information to the application which I/we know or should reasonably know and which is relevant or material for the purpose of application. Any misrepresentation may lead to disqualification.
  2. 本人／吾等明白此項申請所要求之一切個人資料均由申請人自願提供，未能提供有關資料及其他所需文件將可能影響是項「賽馬會齡活城巿『全城‧長者友善』計劃」 (下稱「本計劃」)之申請及其結果。
    I/We understand that the provision of all personal data requested in this application is voluntary and failure to provide such information and other required documents may affect the processing and outcome of the application for “Jockey Club Age-friendly City Partnership Scheme” (the “Scheme”).
  3. 本人／吾等謹此聲明，本人／吾等已閱讀、清楚明白及同意香港賽馬會慈善信託基金(下稱「信託基金」)的私隱政策聲明(有關聲明已刊登於： http://www.hkjc.com/home/chinese/corporate/corp_privacy_hkjcct.aspx) 之內容。在不影響有關私隱政策聲明的一般性內容下：
    I/We declare that I/we have read and fully understand and agree with the contents of the Privacy Policy Statement of The Hong Kong Jockey Club Charities Trust (the “Trust”) which could be found at http://www.hkjc.com/home/english/corporate/corp_privacy_hkjcct.aspx. Without prejudice to the generality of the contents of the Privacy Policy Statement:
    • 本人／吾等同意及承諾所有提供予信託基金、香港賽馬會（ 下稱「賽馬會」）或任何與信託基金在本計劃合作的第三方機構（下稱「合作機構」）所使用的個人資料，經已獲得其他僱員或其他當事人之所有必要的同意及授權，按信託基金之私隱政策聲明之規定使用其個人資料。有關的私隱政策聲明請瀏覽網頁：http://www.hkjc.com/home/chinese/corporate/corp_privacy_hkjcct.aspx
      I/We agree and undertake to obtain all necessary consent and authorisation from my employees or any other party to provide their personal data for the use of the Trust, The Hong Kong Jockey Club (the “Club”) or any third party collaborating with the Trust in the Scheme (the “Collaborators”) for the purposes as stated in its Privacy Policy Statement. The Privacy Policy Statement can be viewed at: http://www.hkjc.com/home/english/corporate/corp_privacy_hkjcct.aspx
    • 本人／吾等同意信託基金、賽馬會及／或其合作機構於不同渠道（如網站、社交平台、刊物及其他公眾渠道）為推廣或報告本計劃而刊登本人／吾等在本計劃所提供的個人資料，例如姓名、聯絡資料、網址及其他有關的資料。
      I/We agree that the Trust, the Club and/or the Collaborators may publish the information provided by me/us under this Scheme, including any personal data, such as the names, contact details, website address and any other relevant information via various channels (such as websites, social media platforms, publications and other public channels) for the purposes of promoting or reporting of the Scheme and the Jockey Club Age-friendly City Project.
    • 本人／吾等明白並同意信託基金或賽馬會可能使用本計劃內的個人資訊及聯絡資料作未來溝通及互動之用。
      I/We agree that the Trust or the Club may use the personal data and contact information provided under the Scheme for future communication and engagement purposes.
  4. 本人／吾等同意，在法律適用範圍內，信託基金、賽馬會及其僱員或代理人無須就任何因處理本人／吾等申請時的行為、過失或疏忽；或不當使用本計劃的標誌、標貼及證書而引致的投訴或民事訴訟；或任何就本計劃及賽馬會齡活城市計劃的執行及管理所導致或所涉及的原因，所引致之損失承擔法律責任。
    I/We agree that to the extent as permitted by the applicable laws, the Trust, the Club and their employees or agents shall not be liable to me/us for any loss caused by the act, default or neglect of the Trust, the Club or their employees or agents in the processing of my/our application, complaints or any other claims against improper use of the Scheme logo, sticker and certificate or any cause whatsoever arising out of or in connection with the implementation and management of the Scheme and the Jockey Club Age-friendly City Project.
  5. 本人／吾等知悉及同意信託基金、賽馬會及其僱員和代理人並無就有關本計劃所提供的建議或材料，作出任何明示或默示的陳述、保證或說明。
    I/We acknowledge and agree that the Trust, the Club and their employees and agents do not make any representations, warranties or statements (whether express or implied) of any kind in respect of any recommendations or materials provided by the Trust, the Club and/or the Collaborators in relation to the Scheme or otherwise.
  6. 本人／吾等知悉及同意信託基金、賽馬會及其僱員和代理人不會就本計劃之任何參加者或其任何僱員或顧客或任何其他人士所引致而蒙受或遭他人提出的損害、損失、法律責任、訴訟、法律程序、申索、要求、費用或開支，而負有任何責任。
    I/We acknowledge and agree that the Trust, the Club and their officers and employees and agents shall not be liable for any damage, loss, liability, action, proceedings, claim, demand, costs or expenses suffered by or brought against any participant in the Scheme or any of its employees or customers or any other person arising out of or in relation to the Scheme.
  7. 本人／吾等已被建議應就參加本計劃而涉及的事宜自行尋求獨立專業意見。
    I/We have been advised to seek independent professional advice on matters arising out of or in relation to their participation in the Scheme.
  8. 如對本計劃或賽馬會齡活城市計劃有任何查詢，請瀏覽本計劃之網站(www.jccitypartnership.hk) 或致電+852 3500-9477或電郵至 info@jccitypartnership.hk 聯絡計劃秘書處。
    For enquiries on the Scheme or other information on the Jockey Club Age-friendly City Project, please refer to our official website (www.jccitypartnership.hk) or contact the Scheme’s Secretariat at +852 3500-9477 or info@jccitypartnership.hk.
  9. 如欲查詢已提供之個人資料，包括查閱及更正資料，請致電+852 3500-9477或電郵至 info@jccitypartnership.hk聯絡計劃秘書處。
    For enquiries concerning the personal data provided, including the making of access and corrections, please contact the Scheme’s Secretariat at +852 3500-9477 or info@jccitypartnership.hk.
本申請表格之中英文版本如有任何抵觸或不相符之處，應以英文版本為準。
In the event of any conflict or inconsistency of the English and Chinese versions of the terms and conditions set out in this Application Form, the English version shall prevail.

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