Family Chan Camp Application Form 法鼓山親子營 報名表
Harry Potter defeated all his enemies. Come find out how you can have no enemies!

Sponsored by Dharma Drum Mountain Buddhist Assosication

Date: 8/2/2017 (Wednesday) 5:30 pm – 8/6/2017 (Sunday) 11:00 am
Camp Location: Dharma Drum Retreat Center, Pine Bush, New York
Kids: Ages 7-11
Teens: Ages 12 or older
Adults

Fee: $350/person for child or adult attending alone. $300/person for child(ren) and parent(s) come together.
For children ages 10 and under, we strongly encourage at least one parent/guardian attend with the children. Children ages 10 and under not accompanied by an adult may be put on waiting list.
Please make check payable to DDMBA and mail to 91-26 Corona Avenue, Elmhurst, NY 11373. Your slot is not reserved until payment is received.

Registration Deadline: 7/22/2017 or until slots are filled

Note: Child participants must be 7 or older by the start of the camp.

Contact familychancamp@ddmba.org for any question. Application form must be filled out below.

Email address
1st child's first and last names
Your answer
1st child's Chinese name
請輸入中文
Your answer
1st child's age on 08/02/2017
Your answer
1st child's gender
2nd child's first and last names
Your answer
2nd child's Chinese name
請輸入中文
Your answer
2nd child's age on 08/02/2017
Your answer
2nd child's gender
3rd child's first and last names
Your answer
3rd child's Chinese name
請輸入中文
Your answer
3rd child's age on 08/02/2017
Your answer
3rd child's gender
4th child's first and last names
Your answer
4th child's Chinese name
請輸入中文
Your answer
4th child's age on 08/02/2017
Your answer
4th child's gender
1st parent/guardian's first and last names
Your answer
1st parent/guardian's Chinese name
請輸入中文
Your answer
1st parent or guardian?
1st parent or guardian attending the camp?
2nd parent/guardian's first and last names
Your answer
2nd parent/guardian's Chinese name
請輸入中文
Your answer
2nd parent or guardian?
2nd parent or guardian attending the camp?
Email address
All communication regarding the camp will be sent to this email address, including confirmation of application. Please double check to make sure it is correct.
Your answer
Cell phone
Your answer
Home phone
Your answer
Street address
Your answer
City
Your answer
State
Your answer
ZIP Code
Your answer
1st emergency contact name
Your answer
1st emergency contact phone number
Your answer
1st emergency contact relationship
Your answer
2nd emergency contact name
Your answer
2nd emergency contact phone number
Your answer
2nd emergency contact relationship
Your answer
Does any of the applicant have any special medical, physical, emotional or mental needs?
If answer "yes" to above, please explain.
Your answer
Does any of the applicant have any dietary restriction or food allergy?
If answer "yes" to the above, please explain.
Your answer
Parent/guardian consent
I. I grant permission to Dharma Drum Mountain Buddhist Association (DDMBA) to take and publish photographs of my child for any legitimate purposes. II. I do hereby give authority to DDMBA to obtain the necessary emergency medical treatment for my child, with the understanding that the family be notified as soon as possible. III. I understand and agree that DDRC, DDMBA, the staff, and Chan Meditation Center assume no responsibility or liability for any injury, loss, or illness sustained at the camp. I am fully responsible for the damage or loss of my child’s personal belongings. By typing the guardian or parent's full name below, you consent to the above.
Your answer
If you are traveling by car, are you willing to offer additional seats to other campers?
If you need assistance arranging ride, please indicate how many people need rides. ($50/person round trip)
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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