住宿表格 Accommodation Form

• 網上報名Online Application

  諸位法友們，大家好！

  請仔細閱讀及根據您個人的實際狀况，正確地填寫表格。

  如果您的填寫有錯誤，系統將出現紅色標示提醒，請修正以便成功提交。如果提交報名表格成功，您將會收到一份電子郵件，以便確認網上報名登記已成功。

  謝謝！

  Greetings, all dhamma friends!

  Please read the regulations carefully and complete the application form with accurate information.

  All invalid entries will be highlighted in red. Please correct them before submission.You will receive a reply email when the submission is successful.

  Thank You!

• 身份 Identity:*
  • 在家 Lay
  • 僧伽 Sangha
• 出家法號 Ordination name:*
• 英文姓名 Name：*
• 中文姓名 Chinese Name:
• 皈依法名Dharma Name:
• 出生日期 Birth Date:*
  Year2001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

  Month123456789101112

  Day12345678910111213141516171819202122232425262728293031
• 年齡 Age:*
• 性別 Gender:*
  • 男 Male
  • 女 Female
• 身份 Identity:*
  • 比丘 Bhikkhu
  • 比丘尼 Bhikkhuni
  • 式叉摩那 Sikkhamānā
  • 沙彌 Samanera
  • 沙彌尼 Samaneri
• 國籍：*
  MalaysiaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe
• 身份證號碼 NRIC No.:*
  外國籍請填護照號碼(Passport no. for foreigner):
• 宗教信仰 Religion：*
• 職業 Occupation:*
• 出家道場 Place of first ordination:*
• 出家依止師 Acariya:*
• 出家日期 Date of taking ordination:*
• 受具足戒道場 Place of higher ordination:*
• 受具戒師 Preceptor at higher ordination:*
• 受具足戒日期 Date of taking higher ordination:*
• 健康狀況 Health conditions:*
  • 良好 Healthy
  • 欠佳 Unhealthy
• 欠佳狀況 Unhealthy conditions:*
  • 高血壓 Hypertension
  • 心臟病 Heart disease
  • 糖尿病 Diabetes
  • 肝炎 Hepatitis
  • 胃病 Gastric
  • 哮喘 Asthma
  • 打鼾 Snoring
  • 情緒困擾或心理疾病Emotional disorder or mental illness
  • 其他 Others
• 請註明其他病況 Please specify：*
• 血型 Blood Type:*
  • A
  • B
  • AB
  • O
  • 不知 Unknown
• 學歷 Education Level:
  • 小學Primary
  • 中學Secondary
  • 大學、大專 University or College
  • 碩士Master
  • 博士Doctorate
• 聯繫電話 Telephone：*
• 電子信箱 Email:*
• 通訊地址 Address:*
• 推薦人Referred by:*
• 推薦人單位 Referrer's Monastery:*
• 推薦人電話 Referrer's Contact Number：*
• 緊急聯絡人 Emergency Contact Person：*
• 關係 Relationship :*
• 緊急聯絡人電話 Emergency Contact Number：*
• 住宿目的 Purpose of staying:*
  • 義工 Volunteers
  • 禪修 Meditation
  • 上課 Attending class
  • 其他 Others
• 請註明其他住宿目的 Please specify：*
• 住宿日期 Accomodation Date：*
  Date Format: DD slash MM slash YYYY
  從 From
• *
  Date Format: DD slash MM slash YYYY
  至 To
• 備註 Remarks:

• 聲明 DISCLAIMER

  本人願意於寂靜禪林住宿期間遵守一切規約，並聲明以上所填寫之資料正確無誤。 I shall obey the rules and regulations of the monastery during my stay. All the information I have provided above is true.
• 簽名 Signature ：*