法鼓山紐約象岡親子夏令營

2008 DDMBA FAMILY SUMMER CAMP

招生簡章

  營期:2008年7月10日（星期四）下午六時至13日（星期日）下午三時

  結業典禮 / 成果展覽 : 星期日1:00 pm ~ 3:00 pm

  營址: 紐約象岡道場184 Quannacut Road, Pine Bush, NY 12566

  課程內容：體驗、享受大自然的生態，學習禮儀環保，培養健康的人

                 生觀，建立親子間的互動，及製作童玩等.

  師資： 由法師及西方眾師資共同主持。

  報名資格：6歲至16歲的青少年

  名額：150人﹐全部為住宿營，先報先收, 額滿為止。

  報名日期：即日起至六月十五日止，若報名截止前名額已滿，則按照報

                 名先後順序列入候補名單。報名時需繳交填妥及簽名的報名
  
                 表､支票 （恕不收現金）及身體檢查表。報名表請寄至

                  Chan Meditation Center

                  90-56 Corona Ave. Elmhurst, NY 11373

  收費：每位成人$150.00元﹐兒童$100.00元﹐包含食宿﹐六月二十五日

          起恕不退款, 支票請開 DDMBA

            交通費用 (從東初禪寺至象岡﹐雙程往返)：每人$40.00元﹐

         需要 ___ 不需要 ___. (登車地點：東初禪寺, 開車時間：7月10日下午

三點)

  問電話：東初禪寺 718-592-6593 吳淑梅 732-910-0228

              暨網站 www.ddmba.org or www.ddmba-nj.org

 


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2008 DDMBA FAMILY SUMMER CAMP

Program Overview and Application Guide

  Date: July 10 (Thursday) 6:00 PM – 13 (Sunday) 3:00 PM, 2008

Closing Ceremony and Exhibition: Sunday 1:00 – 3:00 PM

Camp Location: Dharma Drum Retreat Center 184 Quannacut Road, Pine Bush, NY 12566

Program Overview: Courses designed to help children be aware of and appreciate natural environment, learn new personal and social skills, build up healthy life goals, improve parent-children relationship, and at the same time enjoy craft making, play performing and some out-door activities.

Teachers: DDMBA Venerable and outstanding English-speaking teachers. Counselors and helpers are available on site.

Eligibility: Children of age from 6 to 16 years.

Capacity: Maximum of 150 participants on first come first serve basis. (Overnight camp).

Application Deadline: Application accepted until June 15, 2008. Will put on standby list if capacity filled before deadline. Notice of acceptance sent on June 20. Submit completed and signed application form, application fee (checks only), and health history form to

        Chan Meditation Center 90-56 Corona Ave. Elmhurst, NY 11373

Application Fee: US$150 per adult, $100 per child, including room and board. No refund after June 25. Make check payable to DDMBA. No cash please.

Transportation Fee (from CMC to DDRC): US$40/person per round trip.

                        Yes ___ No ___. (Pick-Up Place: CMC, Pick-Up Time: 3PM on 7/10)

Questions or more information: Chan Meditation Center 718-592-6593

                           Margaret Wang 732-910-0228

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                            2008 DDMBA FAMILY SUMMER CAMP

APPLICATION FORM

報名表

學生中文姓名：

 

Student Name:

 

Date of Birth: (生日)

     /     /

Sex: (性別)  o Male (男)   o Female (女)

Chinese Listening Capability (中文聽力)：oGood(優)   oAverage(可)   o None(須輔導)

Home Address:

Home Phone:

父親中文姓名：                                                  Father’s Name：

Work/Cell Phone：

Fax No.:

母親中文姓名：                                                  Mother’s Name：

Work/Cell Phone：

Fax No.:

Emergency Contact (緊急情況聯絡人)：

Contact Phone (聯絡人電話)：

Medical Information :The attached form must be filled out by you (1st part) and your physician (2nd part), please also list all known allergies and medical conditions here:

_____________________________________________________________________________

Medical Insurance Carrier: ________________________________________________________

Policy No./Group ID: ____________________________________________________________

 

Release of Liability Statement:

In consideration of the activities at DDMBA Family Summer Camp, 184 Quannacut Road, Pine Bush, NY 12566 sponsored by the DDMBA, it is hereby understood and agreed that the said DDMBA or their officers severally, will not be held responsible for any injury or accident sustained by a member or our party or anyone else.

Emergency Medical Release: In case of emergency, permission in hereby given that my child is to be treated by the area’s hospitals.

Signature of Parent/Guardian: _____________________________ Date: ____________________

Name of Signing Parent/Guardian (Please Print) ________________________________________

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2008 DDMBA FAMILY SUMMER CAMP

Medical History (健康檢查表)

The upper part to be filled in by parent/guardian or adult campers/staff members themselves

 

Name:___________ Date of Birth:_____/_____/19________________ Sex:______

                    First                    Initial                    Last                    Month                    Day                    Year

Father/Guardian:___________ Mother:_____

Address:_____

Phone: (Home)___________ (Work)______

Father/Guardian Mother

Emergency Contact (Please give name, address and daytime phone of two person other then parent/guardian)

Name:___________ Name:______

Daytime Phone:___________ Daytime Phone:___________

Medical History (check and give dates)

Asthma

 

Diabetes

 

Mononucleosis

 

Bleeding disorder

 

Heart disease

 

Psychiatric treatment

 

Chicken pox

 

Hypertension

 

Recurrent ear infection

 

Convulsions

 

Kidney disease

 

Others

 

Past surgical history:_______________ Family medical history:_______________ Allergies:________

Physician:__ Phone:_________ Dentist:__________ Phone:_______________

The lower part to be filled by Physician

Immunization Records

DPT________

HIB________

OPV________

Hepatitis B___

Physical Examination

Ht. _________ Wt. __________ B.P. _________ _________ P ___________                      T _____________

HEENT _____ Lungs _____ Heart _____ Abd _____ Back _____ Ext ____ Neuro ____

I have examined the person described and have reviewed his/her medical history.

He/She is ___ is not ___ with restrictions ___________ to participate in camp activities.

Medication or special diet while in the camp_______

Licensed Physician’s Signature Date___________

Address_____

Phone_______