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2013 North America BLIA Scouts Camp-O-Ree To promote the Three Acts of Goodness, improve the relationship among the BLIA scout troops and to enhance respect for nature and life, the New York BLIA Scouts would like to host the 5th North America BLIA Scouts Camp-O-Ree and sincerely invite your scout troop/pack to come share your scouting experiences with us.

1. Date: July 04 ~ July 07, 2013

2. Location: IBPS – Deer Park 2005 GuymardTurnpike Godeffroy, NY 12739 USA

3. Eligibility: i. Youth: All BLIA Scouts who are at least 8 years old or have completed the first grade in the

elementary school. ii. Adults: All volunteer adults of the scout troop. Adults from IBPS of which there is no scout

troop but is planning to start up one are welcome.

Due to the constraint of the facility at Deer Park, the application is not opened to the siblings of scouts. The organizing committee, while will exercise the best efforts to accommodate all eligible applicants, may have to limit the acceptance of adults. In the event, the application is not accepted, the registration document will be returned and the fee will be refunded in full. Thanking you in advance for your understanding this matter.

4. Projected Number of Participants: It is planed that there will be total of 250 participants,

among which there will be150 scouts and 100 committee and staff.

5. Fee Per Person: US$150.00, non-refundable. Please make the check payable to IBPS

6. Registration Due Date: March 31, 2013

7. Registration: i. Each participant is to complete a registration form. (Attachment 1S for scouts and

Attachment 1A for adults) ii. Each participant is to submit a signed consent form.(Attachment 2)

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iii. Please complete the Airport Shuttle Service Application Form if you need the service (Attachment 3)

iv. The troop will collect for forms and the fee and submit to IBPS New York

8. Contact Information: Mailing address:

Venerable Miao Dao (E-Mail: newyork@ibps.org) IBPS New York 154-37 Barclay Avenue, Flushing, NY 11355, USA Tel: (718) 939-8318Fax: (718) 939-4277

For scout related issues, please contact: Scoutmaster Sheng-Yean Cheng(E-mail: ibpsnyscouts@gmail.com)

9. Medical Form: There is a fair amount of moderate to strenuous physical activities in the Camp-O-Ree. Each applicant is required to submit a copy of the medical form with the signature and stamp from the applicant's physician clearing the applicant from restriction in participating in any activities. The medical form needs to be dated on or after July 8, 2012. The medical form will be kept by each unit for emergency purpose. i. For Cub and Boy Scouts from United States, please complete “Annual Medical and Health

Record A, B and C. rev 09/2012”. ii. For Girl scouts from United States, please use the “Health History and Medical Examination

Form for Minors/Adults” approved by the Girl Scouts of America. iii. For scouts from other country, kindly use the medical form approved by your local council.

10. Tour Plan: Please follow your local scout council guideline in filing the tour plan/permit.

11. Additional Touring: For participants interested in touring New York City or the east coast of

United States and need assistant in planning the tour please contact the travel agency list below for the tour plan.

Mrs. Anita Tien (E-mail: vipflushing@gmail.com) VIP Travel Oriental Inc. 135-23 40th Road, Flushing, New York 11354, USA Tel: (718) 539-0700 Fax: (718)539-7316

Kindly share this invitation to your scout troop/pack. We shall look forward to seeing

you in July 2013.

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第五屆北美佛光童軍大露營

說 明： 為提倡三好運動，尊重自然與生命，培訓童軍生活領域及技能，並加強北美佛光童軍團

聯誼，紐約童軍團敬邀美、加各童軍團參加此大露營

活動日期：2013 年 7 月 4～7 日( 星期四 ～ 星期日 )。

活動地點：佛光山鹿野苑 IBPS–Deer Park

2005 Guymard Turnpike, Godeffroy, NY 12739, USA.

主辦單位：國際佛光會世界總會佛光童軍總團部

承辦單位：紐約佛光童軍團

協辦單位：佛光山紐約道場

參加人員：

1. 美、加各區佛光童團男、女童軍共 150 名

2. 童軍領隊暨團務人員 100 名

活動內容：1.童軍技能 2.探索自然 3.急救常識 4.才藝技能 5.團康活動

參加費用：每人 US $150 （支票抬頭請寫：IBPS）

報名日期：即日起至 2013 年 4 月 30 日止。

報名手續：

1. 凡參加人員每人需填寫一份報名表（Registration)（童軍填寫附件 1S -; 領隊暨團務人員

填寫附件 1A ）

2. 各童軍團員需繳交法定監護人簽具之同意書 (Consent)（如附件 2）

3. 需要交通服務者請填寫「機場接送服務申請表」 （如附件 3）

4. 凡參加之童軍需繳交 2012 年 7 月 8 日後，由醫生開據之健康證明書一份。

5. 各團收齊文件連同支票請寄交主辦單位：

（報名繳費後因故取消者，恕不退費）

聯絡地址： 2013 North America BLIA Camp-O-Ree

ＩＢＰＳ- New York

154-37 Barclay Avenue, Flushing, NY 11355, USA.

聯絡電話： (718) 939-8318 傳真 : (718) 939-4277

聯絡人： 妙道法師 E-mail: newyork@ibps.org

鄭盛元團長 E-mail: ibpsnyscouts@gmail.com

凡需紐約/美東旅遊，請洽以下旅行社：

VIP Oriental Travel Inc.

135-23 40th Road, Flushing, New York 11354, USA.

Tel: (718) 539-0700 Fax: (718)539-7316

聯絡人：Anita Tien E-mail: vipflushing@gmail.com

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Attachment (附件)1S

2013 北美佛光童軍大露營活動報名表 Registration Form for 2013 America BLIA Scouts Camp-O-Ree

Scout (童軍)

Personal Information 個人資料 英文姓名 Name In English: 性別 Gender: □ Male □ Female

中文姓名 Name In Chinese: 襯衫尺寸 Shirt Size: (Based on adult sizes)

(□XS □S □M □L □XL □XXL) 生日 Date Of Birth (mm/dd/yyyy):

Contact Information 通訊資料 住址 Address:

電話 Home Phone: 手機 Cell Phone:

電子信箱 E-Mail:

Scouting Information 童軍資歷 所屬童軍團隊及國籍 Scout Troop #/Nationality:

童軍級別 Scout Ranking:

童軍年資 Years In Scouting:

Health Insurance And Related Information 健保及相關資料

緊急聯絡人 Emergency Contact Person: 電話 Phone Number:

醫療保險公司名稱 Health InsuranceCarrier:

保險號碼 Insurance ID: 與保險人關係 Relationship To The Insurer:

家庭醫生姓名 Family Doctor: 家庭醫生電話 Phone Number:

敏感食物或藥物 Allergy Food/Drug:

慢性病症 Chronic Illness:

用葯近況 Medications In Use:

申請人簽名 Applicant Signature Date:

家長/監護人簽名 Parent/Guardian Signature (if the applicant is under 18 years old)

Print Signature Date

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Attachment (附件)1A

2013 北美佛光童軍大露營活動報名表 Registration Form for 2013 America BLIA Scouts Camp-O-Ree

Adult (領隊暨團務人員)

Personal Information 個人資料 英文姓名 Name In English: 性別 Gender: □ Male □ Female

中文姓名 Name In Chinese: 襯衫尺寸 Shirt Size: (Based on adult sizes)

(□XS □S □M □L □XL □XXL) 生日 Date Of Birth (mm/dd/yyyy):

Contact Information 通訊資料

住址 Address:

電話 Home Phone: 手機 Cell Phone:

電子信箱 E-Mail:

Scouting Information 童軍團資歷

所屬童軍團隊及國籍 Scout Troop #/Nationality:

童軍團職務 Adult Position:

童軍年資 Years In Scouting:

Health Insurance And Related Information 健保及相關資料

緊急聯絡人 Emergency Contact Person: 電話 Phone Number:

醫療保險公司名稱 Health InsuranceCarrier:

保險號碼 Insurance ID: 與保險人關係 Relationship To The Insurer:

家庭醫生姓名 Family Doctor: 家庭醫生電話 Phone Number:

敏感食物或藥物 Allergy Food/Drug:

慢性病症 Chronic Illness:

用葯近況 Medications In Use:

申請人簽名 Applicant Signature Date:

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Attachment(附件)2

CONSENT I understand that participation in the 2013 North America BLIA Scouts Camp-O-Ree being held at IBPS-DeerPark, 2005 Guymard

Turnpike, Godeffory, NY 12739, USA, involves certain degree of risks. I have carefully considered the risks involved and have given consent

for my child and/or myself to participate in the activity. I understand that participation in the activity is entirely voluntary and requires

participants to abide by applicable rules and standards of conduct. I release the Boy Scouts of America, the Boy Scoutslocal council, the Boy

Scout Troop 754, the Cub Scout Pack 754, the Girl Scouts of America, the local council, the Girl Scout Troop 4566, 4567, 4568, 4569 and 4570,

the International Buddhist Progressive Society, the activity coordinators, and all employees, volunteers, related parties, or other

organizations associated with the activity from any and all claims or liability arising out of this participation.

In case of emergency involving my child, I understand that every effort will be made to contact me. In the event I cannot be reached, I

hereby give my permission to the medical provider selected by the adult leader in charge to secure proper treatment, including

hospitalization, anesthesia, surgery, or injections of medication for my child. Medical providers are authorized to disclose to the adult in

charge examination findings, test results, and treatment provided for purposes of medical evaluation of the participant, follow-up and

communication with the participant’s parents or guardian, and/or determination of the participant’s ability to continue in the program

activities.

In addition I understand that while participating in this kind of activity or related activities I may be photographed. I understand that

the term “photograph” as used herein encompasses all still photographs, audio recording and motion picture footage. I understand and

agree that the photograph(s) may be used in whole or in part, at any time, in composite or distorted form, in color or otherwise and may be

displayed through any medium including, but not limited to printed medium, video or on the Internet. By signing this waiver I authorize any

initial and any subsequent disclosure or publication of the photograph(s) in all domestic and foreign territories at any time.

x_____________________________________Age:____________

PRINT NAME

x_____________________________________Date:____________

PARTICIPANTS SIGNATURE

FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE

(UNDER AGE 18 AT TIME OF REGISTRATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided

above of all the Releasees, and, for myself, my child and our heirs, assigns, and next of kin, I release and agree to indemnify and hold

harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these programs as provided

above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law.

X_______________________________ /___________________________Date:____________

PARENT/GUARDIAN SIGNATURE PRINT NAME

X_______________________________ /___________________________Date:____________

PARENT/GUARDIAN SIGNATURE PRINT NAME

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Attachment(附件) 3

2013 北美佛光童軍大露營機場接送申請表

2013 North America BLIA Scouts Camp-O-Ree Shuttle Service Application Form

童軍團隊名稱： Scout Troop

國籍/州別： Nationality/ State

領隊姓名： Name of Leader

聯絡電話： Leader’s Cell Phone

Arrival Departure 日期 Date

時間 Time

機場 Airport

☐LaGuardia ☐JFK

☐LaGuardia ☐JFK

航空公司 Airline

班機號碼 Flight No.

人數 No. of Person

行李件數 No. of Luggage

請於 2013 年 6 月 15 日前傳真或 Email 至主辦單位。Please Fax or Email before June, 15, 2013 Tel: (718) 939-8318 Fax: (718) 939-4277 E-mail: newyork@ibps.org and ibpsnyscouts@gmail.com