青少年禅修营报名表

2020 the 7th Summer Youth Meditation Camp Application Form

本人及参加营队孩童已充分了解「2020年第七届暑期青少年卓越禅修营小菩萨行前同意书」所载内容，并同意本人子女于2020年8月3日至2020年8月8日，六天期间参加本寺规划之所有课程活动，并遵守相关规范。

YES 同意*
Name of Parent 家长姓名:*
Participant’s Special Health Conditions:
您的孩子是否有特殊健康情况 ?
If applicable, please provide more details on the health conditions or allergies.
请提供关于健康状况及过敏的详细资料。
In case of a severe allergy or anaphylactic reaction, I agree to provide my child with the appropriate EpiPen to be used during such a reaction. If any other course of action needs to be taken (such as other emergency medication eg. antihistamines, puffers, etc), please state below and ensure that the camp staff have access to these medications.
Youth English Name*
Youth Chinese Name*
Date of Birth:*
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Gender:*
Day School:*
Day School Grade*
Youth OHIP Health Card Number:*
Parents E-mail:*
Father’s legal Name:*
Father’s Cell phone#:*
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Mother's legal Name:*
Mother’s Cell phone#:*
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Home address:*
Emergency Person’s Name:*
Emergency Person’s Cell phone#:*
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Home Language:*
Other Language:
Referral by 介绍人:*
Suggested Donation: Tuition fee：CAD $800/ per participant 每位小朋友
Payment Methods:*

以下部分，请由小孩自行填写：

What’s your Chinese level?:*
Have you participated in Youth Meditation camp before? If yes, what year and what you had learnt? *
What’s the motivation for you to attend the camp?*
Have you participated in Great Compassion Bodhi Prajna temple’s weekend youth program?*
How long do you think you can sit quietly and still? *
What’s your hobbies and interests?*
Please describe yourself in a couple of sentences.*
Date:*
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By submitting this form, you have read and agree to camp agreement; you also confirm that the information given in this form is true, complete and accurate.

YES 同意*