華府慈濟人文學校暑期生活營報名表 Summer Camp Registration Form

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「敬天愛地聚福園」是今年營隊的主題，藉由課程,活動與遊戲，引導學員懂得對自己負責任，啟發學員付出愛心關懷別人，進而學會珍惜資源，愛護我們生活的環境。
The theme of this year's summer camp is "Respecting the Environment to Create Blessings." Through activities and games, campers will explore how to care for themselves, others, and the environment.

學員 6 歲至15歲（7歲以下需家長陪同參加)
Camper: 6 to 15 years old (Children 7 years old or younger will need parent supervision)

培訓輔導員 16歲至18歲
Counselor-in-Training: 16 to 18 years old

費用：人文學校學生是$50.00 否$70.00
Cost: Tzu Chi Academy Student $50, Non-Student $70)

上網填寫報名資料後，請完成免責任及醫療授權書，連同支票或現金交學校註冊組或寄到：
Checks payable to:
Tzu Chi Academy, 1516 Moorings Drive, Reston, VA 20190
Attn: Tzu Chi Academy – Summer Camp
《支票抬頭請寫 Payable to: Tzu Chi Academy，報名費不能抵稅 Registration fee cannot be tax-deductible》

中文名字 Chinese Name *

英文名字 English Name *

First and last.

生日/Birth Date: *

Please format as: (mm/dd/yyyy).

性別/Gender: *

男 Male

女 Female

Required

中文學校年級/Chinese School Grade: *

英文學校年級 Public School Grade *

制服尺寸/Uniform Size: *

Youth S/M/L, Adult S/M/L

住址/Address: *

電話/Telephone: *

Please format as: (xxx) xxx-xxxx.

電子郵件/Email: *

父親中文姓名/Father’s Chinese Name: *

母親中文姓名/Mother’s Chinese Name: *

緊急聯絡人/Emergency Contact: *

聯絡人的關係Contact Relation *

電話/Telephone: 行動電話/Cell Phone: *

Please format as: (xxx) xxx-xxxx.

若需特殊健康照顧請告知/Please notify us of any dietary needs and special health conditions:

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