Three Refuges Five Precepts Form - International Buddhist Society

First Name*
Last Name*
Chinese Name
Email*
example@example.com
Phone Number*
Format: (000) 000-0000.
Gender

MaleFemale
Age

Below 2525-55Above 55
Languages

EnglishCantoneseMandarinOther
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
The Three Refuges

The Three Refuges
Five Precepts

Abstain from Killing PreceptAbstain from Stealing PreceptAbstain from Sexual Misconduct PreceptAbstain from False Speech PreceptAbstain from Intoxicants Precept
Dharma Name (If already taken Refuges)
Date of Taking Refuges

MonthDayYear
Date
Name of Teacher
If you are taking the Three Refuges, you will need a Buddhist black robe. If taking the precepts, you will need a Buddhist black robe and a Precepts Sash.
Do you require a Buddhist black robe or Precepts Sash?*

YesNo
If yes, please select the item(s) you need:

Black RobePrecepts Sash
Height :
Weight :
Are you interested in volunteering?

YesNo
If yes, please select the area you are interested in volunteering for:

Clerical WorkEventsKitchenGardeningOther
Remarks
Date*

MonthDayYear
Date
Signature
*
Should be Empty: