附件 4-1

2019 BLIA Scouts World Jamboree at Deer Park

I. Objective:1. To strengthen family activities for Buddha’s Light Scouts for encouraging scouts members and

children to pursue knowledge and to enrich their summer vacation. 2. To enhance knowledge of the world and appreciate the cultures and mores of different countries

through Buddha’s Light Scouts and nurture world scouts brotherhood through activities. 3. To experience life through communal living, to explore the wonders of nature through outdoor

camping, and to enhance interpersonal relationships through daily living. So participants can learn to respect others, make broad affinities, and enhance wisdom through learning for nurturing good citizens who: “do good deeds, speak good words, and have good thoughts.”

II. Theme: Unlock a New WorldIII. Dates: July 4-7, 2019IV. Location: IBPS Deer Park, 2005 Guymard Turnpike, Cuddebackville, NY 12729, USAV. Advisor Organization: Fo Guang Shan Monastery

VI. Organizer: BLIA World Headquarter / IBPS New YorkVII. Institution-in-Charge: Buddha’s Light Scouts New York/ Buddha’s Light Scouts Toronto

VIII. Co-organizer: BLIA New YorkIX. Participants:

1. Eligibility: i. Youth: All BLIA Scouts aged 14~18 years old.

ii. Adults (Staff): All adult volunteers of the scout troops. Adults from IBPS with no scout troops but planning to start one are welcome. Rover or Venturing Scouts 19 years old or older will serve as staff at the Jamboree.Due to constraints of the facility at Deer Park, application is not open to the siblings of scouts. While the organizing committee will make every effort to accommodate all eligible applicants, the number of adults to be accepted may be limited. If the application is not accepted, the registration form will be returned and fees refunded in full. Your understanding will be much appreciated.

2. Projected Number of Participants: A total of 275 participants which will include 200 scouts and 75 staff members.

3. Fee Per Person: i. Scouts: US$200.00

ii. Staff: US$150.00iii. All fees are non-refundable except for under the condition when the application is not accepted

as specified under “Eligibility.” Please make checks payable to IBPS.X. Registration:

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1. Due Date: March 31, 20192. Registration procedure: 3. Every participant is to complete a registration form. (Attachment 1S for scouts and Attachment 1A

for adults)4. Every participant is to submit a signed consent form. (Attachment 2)5. Please complete the Airport Shuttle Service Application Form if you need the service. (Attachment

3)6. Medical Form: There is a fair amount of moderate to strenuous physical activities during the

Jamboree. Each applicant is required to submit a copy of 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, 2018 and will be kept by each unit for emergency purpose. Please use the standard medical form approved by the scout council of your country for this purpose.

7. To register: Each scout unit will collect all forms and fees of its unit and submit them to BLIA World Headquarters, BLIA chapters worldwide, Fo Guang Shan branch temples or BLIA scout troops worldwide. Please email or fax completed registration forms to: blia.scout@msa.hinet.net (886)-02-3765-1582

XI. Post Jamboree Tour (Optional)Participants interested in touring New York City and the East Coast of United States, please refer to Attachment 4 for details and indicate your decision in the registration form.

XII. Miscellaneous:1. Tour Plan: Please follow your local scout council guidelines in filing the tour plan/permit as needed.2. Every scout under 18 years old needs to prepare a consent for travel signed by both parents to avoid

any delay at US Customs and Immigration. While notarization of the consent is not required, it is highly recommended.

Kindly share this invitation to your scout unit. We shall look forward to seeing you in July 2019.

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2019佛光童軍世界大露營-鹿野苑一 說 明：

1. 加強佛光童軍親子運動，鼓勵佛光童軍及兒童追求新知並充實兒童青少年暑期生活。2. 結合世界佛光童軍活動提供兒童：暸解世界、認識各國風土民情，從活動中培養世界佛光兄弟情誼，與世界接軌。

3. 從團體生活中體驗人生，並從野外活動中認識自然奧秘養成惜福習性，在生活中增進人際關係，尊重他人廣結善緣，並從學習中增長智慧，培養『說好話、做好事、存好心』的三好童軍。

二 主 題: 開啟一個新世界三 日 期: 2019年 7月 4～7月 7日( 星期四 ～ 星期日 )。四 地 點: 佛光山鹿野苑 IBPS–Deer Park 2005 Guymard Turnpike, Cuddebackville, NY 12729, USA.五 指導單位: 佛光山寺六 主辦單位: 國際佛光會、紐約道場七 承辦單位: 紐約佛光童軍團、多倫多佛光童軍團八 協辦單位: 紐約協會九 報名參加:

1. 參加對象：a) 童軍: 各區佛光男、女童軍十四～十八歲 共 200名b) 工作人員: 童軍領隊,團務人員暨十九歲以上羅浮童軍 75名

2. 參加費用：童軍每人US $200, 工作人員每人US $150（支票抬頭請寫：IBPS）十 報名手續：

1. 報名日期：即日起至 2019年 3月 31日止。2. 凡參加人員每人需填寫一份報名表(Registration)（童軍填寫附件一 S, 領隊暨團務人員填寫附件一

A ）3. 各童軍團員需繳交法定監護人簽具之同意書 (Consent)（如附件二）4. 需要交通服務者請填寫「機場接送服務申請表」 （如附件三）5. 凡參加人員需繳交 2018年 7月 8日之後日期， 由醫生開據之體檢表一份。請使用所屬國家童軍總部體檢表

6. 鑑於鹿野苑場地的限制可能無法接納所有工作人員報名，若報名未被接受報名表和報名費全數退還

7. 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 8. 報名地點：國際佛光會世界總會各協會、佛光山各道場或各地佛光童軍團。報名表請 Email或傳真：blia.scout@msa.hinet.net (886)-02-37651582

十二 紐約/美東旅遊:大露營後有興趣參加紐約美東旅遊者請參考附件四並標示在報名表內

十ㄧ雜項:1. 各團請依照各國童軍總部規定呈報國外旅遊2. 十八歲以下童軍須準備父母簽字旅遊同意書，美國海關建議同意書並經公證，以避免耽誤入關

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Attachment (附件) 1S

2019佛光童軍世界大露營報名表Registration Form for 2019 BLIA Scouts World Jamboree

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

護照 國家/ 號碼 Passport Country/Number: 露營後參加旅遊 Participating in Post-Jamboree Tour□ 參加 (Yes) □ 不 參加 (No)

Contact Information通訊資料 住址 Address:

電子信箱 Email:

電話Home Phone: 手機 Cell Phone:

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:

電話Phone Number:

與申請人關係Relationship:

醫療保險公司名稱Health Insurance Carrier:保險號碼Insurance ID:

保險人Insurer:

與申請人關係Relationship:

家庭醫生姓名Family Doctor:

家庭醫生電話Doctor’s 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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家長/監護人簽名 Parent/Guardian Signature (if the applicant is under 18 years old)

Print Signature Date

Attachment (附件) 1A

2019佛光童軍世界大露營報名表     Registration Form for 2019 BLIA Scouts World Jamboree

Staff (工作人員)

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: (Adult sizes)( □XS □S □M □L □XL □XXL)生日

Date of Birth (mm/dd/yyyy): 護照 國家/ 號碼 Passport Country/Number: 露營後參加旅遊 Participating in Post-Jamboree Tour

□ 參加 (Yes) □ 不 參加 (No)Contact Information通訊資料

住址Address:

電話Home Phone:

手機Cell Phone:

電子信箱 Email:

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:

電話Phone Number:

與申請人關係Relationship:

醫療保險公司名稱Health Insurance Carrier:保險號碼Insurance ID:

保險人Insurer:

與申請人關係Relationship:

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家庭醫生姓名Family Doctor:

家庭醫生電話Doctor’s 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:Attachment (附件) 2

2019佛光童軍世界大露營同意書2019 BLIA Scouts World Jamboree

CONSENTI understand that participation in the 2019 BLIA Scouts World Jamboree being held at IBPS Deer Park, 2005 Guymard Turnpike,

Cuddebackville, NY 12729, 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 Scouts local council, Boy

Scout Troop 754, Cub Scout Pack 754, Venturing Crew 754, Girl Scouts of America, the Girl Scouts local council, 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/my child 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

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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

Attachment (附件) 3

2019佛光童軍世界大露營機場接送申請表2019 BLIA Scouts World Jamboree

Shuttle Service Application Form

請安排接送機場於紐約拉瓜底雅或甘迺迪機場 (Please arrange your arrival and departure airport be at either LaGuardia or JFK Airport in New York City.)

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:

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請於 2019年 6月 15日前傳真或 Email至 Please Fax or Email before June 15, 2019 toFax: (718) 939-4277

E-mail: newyork@ibps.org and ibpsnyscouts@gmail.com

Attachment (附件) 4

七月八日- 十二日旅遊 (Tour itinerary July 8-12, 2019)

1) 7/8（星期一 Monday）紐約巿觀光 全日紐約巿區觀光：世界金融中心華爾街、銅牛，美國聯邦廳、三一大教堂。乘搭觀光遊輪，暢遊港灣並一睹美國自由 精神的象徵－自由女神像，盡情的拍照留念。遊覽世貿中心遺址， 新世貿中心，高度 1776英尺象徵著美國通過獨立宣言的 1776年。登上花費 1.2億美元重新整修開放的國家歷史文物—大無畏號航空母艦， 並參觀協和號超音速客機和潛艇。驅車經洛克菲勒廣場、第五大道、聖派翠克大教堂,抵達美國最大且名列世界三大藝術 博物館之一的大都會博物館，導遊帶領講解參觀，讓您流連忘返。 自費專案：自由女神游輪、航空母艦博物館 。 自費專案：自由女神游輪、航空母艦博物館 Touring New York City, Wall Street, Trinity Church, World Trade Center, Intrepid Sea Air and Space Museum,

Rockefeller Center, Fifth Avenue, St. Patrick Church

2) 7/9（星期二 Tuesday）紐約—尼加拉瀑布 驅車前往尼加拉瓜大瀑布—「美國瀑布」，「馬蹄瀑布」及「新娘面紗瀑布」，水勢一瀉千里，雷霆萬鈞。晚上，還可以在美國境內觀賞瀑布迷人的夜景。 New York City – Niagara Falls: American Falls, Horseshoe Falls

3) 7/10（星期三 Wednesday) 尼加拉瀑布—Watkins Glen State Park—費城 搭乘著名的「霧中少女號」遊船穿梭于波濤起伏的瀑布間，刺激緊張。前往Watkins Glen State Park，參觀後前往費城 入住酒店。 自費專案：霧中少女號遊船（夏天）Niagara Falls – Watkins Glen State Park – Philadelphia: Maid of the Mist Boat Ride, Watkins Glen State Park,

Philadelphia

4) 7/11（星期四 Thursday）費城—華盛頓特區 早上參觀費城地標獨立宮及自由鐘；之後前往美國的首都—華盛頓特區，抵達後外觀國會大廈（週六不開）、白宮，參 觀傑佛遜紀念堂、林肯紀念堂、越戰紀念碑、韓戰紀念碑，總統博物館，以及史密斯桑尼亞博物館。 Philadelphia-Washington DC: Philadelphia: Independence Hall, Liberty Bell; Washington DC: United States Capital,

White House, Thomas Jefferson Memorial, Lincoln Memorial, Vietnam Veterans Memorial, Smithsonian Museums.

5) 7/12（星期五 Friday）華盛頓特區—Luray Caverns —紐約 前往 Luray Caverns，然後返回紐約，行程結束。自費專案：Luray CavernsWashington DC – Luray Caverns-New York City. End of the tour

基於 40人包團報價 (Based on a group of 40 people)：A. 兩人一房 (2 People per room)：每人(Per person) USD $730.25

B. 三人一房 (3 people per room)：每人(Per person) USD $680.25

C. 四人一房 (4 people per room)：每人(Per person) USD $650.25

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團費包括 (The quotes includes)：A. 4晚酒店住宿含早餐 (4 night hotels with breakfast),

B. 5頓團式午餐 (5 lunches)、C. 4頓團式晚餐 (4 suppers) ,

D. 56座巴士 (56 passengers tour bus)，E. 中文導遊 (Chinese speaking tour guide)，F. 小費 (Tips)、G. 下列門票（Admission fees to the followings): Watkins Glen State Park, Luray Caverns, The Lady of Mist Boat

Ride, Statue of Liberty Boat Tour, Intrepid Sea Air and Space Museum

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