Liên Hoa Buddhist Temple
Registration Form for The 201
Bodhi Youth Camp Summer Retreat
Please fill out separated individual form for each participant.
: Dharma Name:
Have you participated in any summer camp or meditation retreats before?
Please share with details.
Have you practiced meditation or exposed to meditation before?
If yes, how long have you been practicing? Please share with details.
Name of parents or
Name of emergency contact
: Relationship with
Is there any health/medical concerns? Is the participant taking any
medications? Allergy? Please attach any relevant medical/health record if
it is important for the camp coordinator to know.
Agreement of the camp participant and parents/guardian
By signing below, I agree for the above participant’s name to participate
in this 2019 Youth Camp Summer Retreat at Lien Hoa Buddhist Temple, MN
from August 2-4, 2019.
1. I will diligently follow the camp rules and regulations.
2. I will not create difficulty or have Lien Hoa Buddhist Temple hold
liability for anything if unfortunate incidents such as injury or loss
happen during the camp.
3. Parents/guardian will bring the participant home right away if the
participant fails to follow the rules and regulations of this summer camp
4. Parents/guardian will bring the participant to the camp and will pick up
the participant from the camp promptly on time.
*** Please accept and allow my child to participate in this 2019 Youth Camp
Summer Retreat at Lien Hoa Buddhist Temple. I have reviewed this summer
camp retreat program and its rules and regulations in details with my
child, which we agreed to follow.
Bottom of Form
Parent’s or Guardian’s signature:
CAMP GUIDELINES & WAIVER
Bodhi Youth Camp Summer Retreat
To ensure every camp participant has a safe and effective learning
environment as well as having a good time at the camp, we request that
every camp participant diligently follow these camp guidelines at the
Lien Hoa Buddhist Temple:
1. Always being respectful to the teachers, camp counselors, volunteers and
friends at the camp.
2. Wear appropriate clothing at the temple. No sleeveless top. No
mini-shorts. No swimsuits.
3. Live in harmony among others at the camp. Interact calmly and nicely
with others. Practice kindness. Practice being humble and content with what
4. Avoid saying or doing anything that could potentially hurt other
5. Not bringing guns, alcohol products, tobacco products, or any other
illicit drugs to the temple campus.
6. Be responsible for your own personal belongings.
7. Do not leave the temple campus without having permission from teachers
or camp counselors.
8. If a camp participant engages in unlawful actions, or demonstrates
violent behaviors that cause harms to self or others, or exhibits
disruptive manners that negatively effect the camp, his/her parent or
guardian will be contacted and will be responsible to bring the camp
participant home immediately.
Waiver of Liability:
I certify that I am the parent/legal guardian for this child (camp
participant). I understand that my child’s participation in this summer
camp at Lien Hoa Buddhist Temple may expose my child to risks of property
damage and bodily or personal injury, including injury that may be fatal. I
knowingly and freely assume, on behalf of my child, any and all such risks
and voluntarily participate in this camp. I understand that it is my
responsibility, as the participant’s parent, to allow my child to engage
only in those activities that are appropriate, and I will communicate this
clearly with the camp counselors and staff.
If my child has certain medical conditions that require urgent care, I give
permission for the camp counselors or staff to provide the most appropriate
immediate care for my child at that time or make emergency decisions for my
child with their best ability, including calling Emergency Medical
Services, to ensure my child’s safety and wellbeing.
I will hold forever harmless and will not take legal action against the
Lien Hoa Buddhist Temple for any claim for damages arising or growing out
of my child’s participation in this activity whether caused by negligence
Media Release Waiver
As parent/guardian, I WILL NOT / WILL grant permission for the Lien Hoa Buddhist Temple to
use a camper’s photograph or other media such as videos for display on
temple’s website, Facebook page, or inclusion in Camp publications. I
understand that Lien Hoa Buddhist Temple respects the wishes of anyone who
prefers not to grant such permission.
By signing below, camp participant and his/her parent/guardian agree to
follow the above camp guidelines and waivers.
Signature of camper:
Signature of parent/guardian:
***Please turn in your registration form prior to July 25th,
2019. You can contact venerable Đức Thành, (714) 343-5562, with any questions or