Application for PolyU Language and Culture Exploration Camp (PLACE) 2018

Date: 17 – 20 July 2018 (Tuesday to Friday)

Venue: The Hong Kong Polytechnic University, Hong Kong

Medium of Instruction: All the activities will be conducted in English

Please fill in the application and upload your latest school transcript.

Applicants will receive a confirmation email no later than 30 June 2018. Successful applicants will be required to pay a refundable deposit within one week from the date of the confirmation email.


The personal data collected in this form will be used by the Faculty of Humanities for sending you the confirmation of the event concerned. For such purpose, it is mandatory for you to provide the data marked with an asterisk (*). We shall not keep the data longer than is necessary, or provide the information to non-PolyU parties for any unrelated purposes without your consent. Please also be informed that photos and videos will be taken during the event for future promotional and educational uses.


There are 27 questions in this form.

Application for PolyU Language and Culture Exploration Camp (PLACE) 2018


Given Name

Chinese Name (if any)


HK ID no./ Passport no.

Date of Birth (dd-mm-yyyy)

Format: dd-mm-yyyy


Name of School

Current Year of Study

Secondary 4/Grade 10
Secondary 5/Grade 11
Secondary 6/Grade 12


Hong Kong Diploma of Secondary Education (HKDSE)
International Baccalaureate (IB)
GCE A-level/ International A-level
Redesigned/ SAT Reasoning Test (SAT)
General Scholastic Ability Test (GSAT)
Unified Examination Certificate (UEC)
Sijil Tinggi Persekolahan Malaysia (STPM)

Email Address

Contact Number (please enter country/area code)

Correspondence Address

Supplementary information

Please tell us the reasons that you would like to join the camp and your expectations.

Subject/discipline(s) you are planning to choose for University study

Language, Culture & Communication
Social Science
Business, Hotel & Tourism Management
Science & Engineering
Not yet decided

Do you need special diet?

Yes (please specify)

Do you have any health conditions that require special attention?

Yes (please specify)

Applicants should upload a copy of your latest academic transcript/school report.
If you cannot upload the transcript now, please send it to as soon as possible.


If you do not wish to receive information from PolyU other than the PLACE camp, please check the box.

Emergency information

Name of Contact Person


Contact Number (Please enter country/area code)


1. Non-local students joining the Camp should arrive Hong Kong on 16 July 2018.

2. Local students (with Hong Kong ID card) have the option to participate the Camp either from 17-20 July (4 days) or 17-19 July (3 days).


I'm a non-local student and will join the 4-day camp (17-20 July 2018).
I'm a local student and will join the 4-day camp (17-20 July 2018).
I'm a local student and will join the 3-day camp (17-19 July 2018).

Please read the following statements carefully.

1. I am, to my own knowledge, currently fit to participate in the PolyU Language and Culture Exploration Camp 2018 (hereafter referred as the PLACE Camp) and do not suffer from any illness, ailment or incapacity that may prevent me from completing the PLACE Camp.

2. I warrant that I fully understand that:

  • The Hong Kong Polytechnic University and its units (hereafter referred as the Organiser) will (to the extent permissible by law) not be responsible for any loss, damage or injury arising from any of my pre-existing medical or psychological condition.
  • If I disobey any safety instruction given to me by the Organiser and as a result of disobeying that instruction, I suffer loss, damage or injury, I will not hold the Organiser liable.

3. I hereby release and discharge the Organiser and its employees to the extent permitted by law, from all Claims which I now or at any time have, or but for this declaration, could or might have against the Organiser in connection with or incidental to my participation in the PLACE Camp or the circumstances recited in this declaration.

4. I hereby guarantee and agree to hold the Organiser, to the extent permitted by law, harmless and indemnified against all Claims which have arisen or may arise in respect of my participation in the PLACE Camp or in any way connected with or arising from, by or on behalf or any person claiming under or by virtue of me.

5. I acknowledge that for the purpose of this declaration “Claims” means actions, suits, causes of action, demands, debts due, costs and expenses and other liabilities of any nature whether present, future or contingent, including but not limited to a claim arising from a negligent act or omission.

6. I acknowledge that I will insure myself against any loss, damage, injury or death that may arise from participating the PLACE Camp, if needed.

7. I acknowledge that the deposit of HK$1,000 will be fully refunded to me upon satisfactory completion of activity, i.e. attended all the scheduled activities. No refund will be made for withdrawal, in full or in part, from the PLACE Camp.

8. I acknowledge that the personal data provided above will be used by The Hong Kong Polytechnic University and its constituent units 1) for processing my application for the PLACE Camp; 2) for record-keeping purpose in relation to issuance of attendance certificate (name and HKID/passport number will be kept in this case); 3) for statistical and research purposes afterwards (with all personal identifiers such as name, HKID/passport number, date of birth, correspondence address, contact number and email address eliminated); and 4) for sending me latest news and updates of PolyU, including programmes offered and activities organised by PolyU. I understand that I can unsubscribe any time in the future and request correction of my personal data held by FH.

9. I declare that I have read, fully understood and have accepted the terms and conditions provided in this declaration.

10. I hereby declare that all the personal information provided above is true and correct to the best of my knowledge.

I hereby agree that all the statements above is true.

To be filled by parent/guardian if the student is under the age of 18 before the departure to Hong Kong or 17 July 2018, whichever is earlier

I am the parent/guardian of the applicant and hereby declare that all the statements above is true.

Name of Parent/Guardian