2025年南天寺皈依暨在家五戒報名表

2025年南天寺皈依暨在家五戒報名表

Nan Tien Temple Taking Refuge and Five Precepts Application Form
提報道場 Registration Branch*
填表人 Who is filling out the form*

戒子本人 Retreat Participants道場代填 Branch Temple Application Handler
填表人姓名 Name Filling the Form
戒子中文姓名 Chinese Name*
Please enter "None" exactly if you don't have a Chinese Name.
English Name of the Preceptee*
Name as shown on passport.
性別 Gender*
生日 Date of Birth*

DayMonthYear
出生地 Place of Birth*
國籍 Nationality*
婚姻狀況 Marital Status*

未婚 Single已婚 Married已婚單身 Divorced/Widow(er)
學習/工作經歷 Academic Achievement & Work Experience
地址 Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
聯絡手機 Mobile Number*
電子郵件 Email (寄發通知單及團體照用，for sending registration notice and group photo)*

Confirmation EmailConfirm email. example@example.com
現職 Occupation*
健康與醫療聲明 Health and Medical Disclaimer
健康與醫療聲明

參加本次戒會修持, 需長時間禁語，並遵循規律的作息安排，對身心皆有一定要求。

若您有任何身體疾病、醫療狀況或心理健康方面的問題，強烈建議您事先諮詢醫生或相關專業醫療人員，以評估是否適合參加此次活動。

南天寺保留權利，在報名時要求您提供醫生開立的健康證明。若未如實提供相關健康資訊，寺方有權拒絕您的報名或於活動進行期間中止您的參加資格。

Health and Medical Disclaimer

Participation in the Retreat involves periods of silence and a disciplined schedule which may be physically and mentally demanding.

Applicants with medical, physical, or mental health conditions are strongly advised to consult with their doctor to determine their suitability to participate.

Nan Tien Temple reserves the right to request written medical clearance from a qualified healthcare provider before accepting your application. Failure to disclose relevant health information may result in the rejection of your application or withdrawal from the retreat at any stage.
健康狀況 Health Conditions(包括食物過敏, 精神狀況等 Including Food Allergies, Mental Health etc. )*
包括食物過敏, 精神狀況等 Including Food Allergies, Mental Health etc.
緊急聯絡人 Emergency Contact*
緊急聯絡人電話 Emergency Contact Tel*
緊急聯絡人關係 Emergency Contact Relationship
使用語言 Language Use*

中文 Chinese英文 English廣東話 CantoneseOther

三皈五戒線上課程 Online Courses on Taking Refuge, Five Precepts

*凡報名受戒者請務必參加課程 (課程時間均為雪梨時間），若未上課者，視為自動放棄受戒資格 *Attendance is compulsory for all applicants; Failure to attend the course will be considered an automatic withdrawal. Courses are scheduled in Sydney AEST Time.
參加皈依者 Taking Refuge*

11月12日（周三） Nov 12th, Wed. 7:30pm OR11月26日（周三）Nov 26th, Wed. 7:30pm
參加五戒者 Five Precepts*

11月19日（周三） Nov 19th, Wed. 7:30pm OR11月26日（周三）Nov 26th, Wed. 7:30pm
佛門禮儀培訓班(必選, 任選其一) Pre-retreat Training Workshops (Compulsory， choose one)*

11 月22日(週六) 1:30pm北雪梨佛光緣 22nd November (Sat) 1:30 pm (Nan Tien Temple Chatswood) 4 Spring St, Chatswood NSW 206711月23日(週日) 1:00pm 南天寺 23rd November (Sun) 1:00 pm (Nan Tien Temple) 180 Berkeley Rd, Berkeley NSW 250611 月29日(週六) 1:30pm南雪梨佛光緣 29th November (Sat) 1:30 pm (Nan Tien Temple Kogarah) 247 Princes Highway, Kogarah NSW 221711月30日(週日) 1:30pm 南天講堂 30th November (Sun) 1:30 pm (Nan Tien Temple Parramatta) 22 Cowper St, Parramatta NSW 2150其他佛光山澳洲各道場 (時間請洽各道場) Other Fo Guang Shan branch temples in Australia

費用 Application Fee
付費項目 Paid Items*

行政費用 Administration Fee $25贊助縵衣 Donations for precept robes: $50
隨喜供齋 Meal Dana Offering
戒會當日午餐將由南天寺準備，歡迎大家隨喜供齋，廣植福田。供齋是佛教中修習佈施、培養慈悲喜捨的重要善行。供養金額，僅為隨緣發心。若金額超過 $50，寺方將寫入齋條，以表感恩與祝福。The lunch on the Precepts Ceremony day will be offered by Nan Tien Temple. You are warmly invited to make a Meal Offering to cultivate merit and compassion. The offering is entirely voluntary, with no fixed amount. For contributions over $50, the temple will include your name in the Meal Offering List as a gesture of gratitude and blessings.
工作人員代碼 Coupon Code
若您有優惠碼，請輸入；否則請留白
✅ 您已使用優惠碼，無需付款，請直接提交表單。
✅ You have used a promo code. No payment is required. Please proceed to submit the form.
總金額 Total Amount
實際付款金額 Final Amount

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

受戒誓言Rules for Eight Precepts Retreat
受戒期間，

1. 恪遵佛陀之戒律，誓不違犯。
2. 遵守佛光山之道風規定及接受教導，誓不違犯。
3. 自願隨眾參與一切必修課業，並自願放棄一切控訴權。

During the Retreat,

1. I vow to follow all Buddhist monastic rules and not to violate any of them.
2. I vow to follow all the teachings of FGS and not to violate any of them.
3. If I incur any injury, I voluntarily waive any claims from Nan Tien Temple.
同意 YES
戒會備註/道場審核意見 Remark/Temple Retreat Application Review Feedback
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2025年南天寺皈依暨在家五戒報名表

健康與醫療聲明 Health and Medical Disclaimer

報名類別 Types of ceremony to be taken

三皈五戒線上課程 Online Courses on Taking Refuge, Five Precepts

費用 Application Fee

受戒誓言Rules for Eight Precepts Retreat

戒會備註/道場審核意見 Remark/Temple Retreat Application Review Feedback