2019 Baby Blessing Ceremony Application     佛光寶寶祝福禮報名表
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CONTACT PERSON INFORMATION 聯絡人資料
1a) Last Name 聯絡人英文姓氏 *
1b) First Name 聯絡人英文名字 *
1c) Chinese Name 聯絡人中文姓名
(If applicable)
2) Relationship to the Child 與寶寶的關係 *
3) Language Preference 使用語言 *
4) Telephone Number 聯絡人電話號碼 *
5a) Home Address 住家地址 *
5b) E-mail 電子信箱 *
( This is the main form of communication; please check for accuracy. 一般聯繫以email為主，請務必確認正確。)
5c) Would you like to receive announcements for future events? 您以後想要得到西來寺的「活動資訊」嗎？ *
CHILD'S INFORMATION 寶寶資料
6b) First Name 寶寶英文名字 *
6a) Last Name 寶寶英文姓氏 *
6c) Child's Chinese Name 寶寶中文姓名
(If applicable)
7) Gender 性別 *
8) Nationality 國籍 *
(As you would like it to appear on their Triple Gem Refuge Certificate. 正如您希望它在皈依三寶證書所顯示。)
9) Date of Birth 出生日期 *
(Format: YYYY / MM / DD.   格式：西元年/月/日)
10) Number of times child has participated in the Blessing Ceremony? 參加西來寺祈福禮次數？ *
11) Dharma Name? 皈依法名 *
如有皈依法名，請填入法名
INTERNATIONAL BUDDHIST PROGRESS SOCIETY EVENT PARTICIPATION AGREEMENT 佛光山西來寺參加活動同意書 :
12) I declare that my child and I are in good physical health and that we are able to participate in the Baby Blessing Ceremony held on July, 4, 2019 and organized by International Buddhist Progress Society. However, if my child or I should experience any physical or health problems during the event and are unable to continue, we will leave voluntarily. If medical care is required for any illness that may occur, I will be fully responsible for the charges. In case of an emergency in regard to my child or my own health condition, I authorize the organizer to take any reasonable immediate action in their best efforts. Should any personal injury or property damage  occur due to my own negligence or intentional acts or any undiscovered sickness that we/I may have during the event, I will be solely responsible and will not hold the organizer, International Buddhist Progress Society (Fo Guang Shan Hsi Lai Temple) or any of its employees or volunteers liable. During the event, if my child or I experience any extraordinary physical conditions which interfere with the practice of other participants, I will accept the directions of the organizer and leave the event without dispute.                                                                                                                                                                        本人及寶寶參加佛光山西來寺於二0一九年七月四日所舉辦的「佛光寶寶祈福禮」活動，於此聲明本人及寶寶之健康情況良好，於活動期間若感身體不適，無法繼續，願自動退出；若因疾病需就醫治療時，願自行負擔全額醫療費用。 於活動期間，如因個人及寶寶疏失，或因本身及寶寶原有隱疾，而發生意外時，本人願擔負起一切責任，主辦單位及服務人員不負任何責任。 於活動期間，如因個人及寶寶身體狀況而引發異狀，因而干擾他人時，本人願接受主辦單位的指示，自動出堂，無有異議。
12a) E-signature *
By typing your name it indicates that you have fully read, understand, and agree to the terms of the above "Event Participation Agreement" in its entirety. 請在下方輸入您的姓名以證驗您已詳細閱讀、了解、並同意以上 "參加活動同意書" 之條目。
12b) Date *
(format: mm/dd/yyyy )
INTERNATIONAL BUDDHIST PROGRESS SOCIETY MEDIA POLICY AGREEMENT :
International Buddhist Progress Society (Fo Guang Shan Hsi Lai Temple) reserves the right to take photographs, images, video, or audio recordings of any and all classes and activities during the event for temple records, website and future publications.
13a) E-signature *
By typing your name it indicates that you have fully read, understand, and agree to the terms of the above "Media Policy Agreement" in its entirety. 請在下方輸入您的姓名以證驗您已詳細閱讀、了解、並同意以上 "謀體政策同意書" 之條目。
13b) Date *
(format: mm/dd/yyyy )
14) Anything you would like us to know or have concerns about? 您有任何疑問 或 事情需要告訴我們的嗎？
15) Number Attending ? 參加祝福禮人數？ *
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