禅修报名表格 | Dhamma Earth

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！重要通知 / Important Notice！

在提交表格前，请确保您已阅读并理解[禅修申请指南页面]上的相关规定。 Before submitting the form, please ensure you have read and understood the guidelines on the [Meditation Application Guideline Page].

首次参与者请至少申请7天禅修，以获得更好的学习体验。 First-time participants must apply at least 7 days in advance for a better learning experience.
请于您希望禅修的日期至少一周前提交申请。 Submit your application no later than one week before your preferred retreat date.

建议 Recommendation: 为了确保申请流程顺利，请使用电脑浏览器填写表格，而非手机设备。 For a smooth application process, please use a computer browser instead of a mobile device.

如需进一步帮助，请直接联系道场。 For further assistance, kindly contact the monastery directly.

I'm 我是

姓名 Name*

依护照/IC as per Passport/IC

法名 Dhamma Name

戒师 Preceptor Name (Upajjhāya)*

出家年份 Ordain Year *

雨安居年份 Vassa*

禅修道场 Retreat Location*

禅修/短期出家营 Meditation/Novitiate Camp*

禅修开始日期 Retreat Start Date*

请在您想要来禅修的日期至少一个星期前提交申请。 Please submit your application at least one week before the date you would like to come to the meditation retreat.

请勿在被批准前擅自购买机票。Please DO NOT buy flight tickets prior our approval of your application.

禅修结束日期 Retreat End Date*

我或许会想申请短期出家。I may apply for short term ordination.*

禅修期间我愿意做一些服务工作。I am willing to do some service during retreat.*

寺院缺乏人手，或许会需要帮忙早午餐供养。As monastery lack of manpower, we might need help for meal offerings.

出生日期 Date of Birth (日/月/年 Date/Month/Year）*

国籍 Nationality

马来西亚人 Malaysian

非马来西亚人 Non-Malaysian

国籍 Nationality *

年龄 Age *

护照号码 Passport No*

护照截止日期 Passport Expiry Date*

签证截止日期 Visa Expiry Date

性别 Gender*

身份证号码 NRIC No *

宗教 Religion*

电邮地址 Email address*

请勿使用 yahoo 或 ymail 电邮地址。 Please not to use yahoo or ymail email address.

电话 Contact Number*

Eg: +6010-1234567

微信号 Wechat ID

中国贤友请务必提供微信号，以方便联络。也可请加法域微信号: dhammaearthsemenyih 。

戒师名 Upajjhaya’s Name*

出家日期 Ordination Date*

出家地点 Place of Ordination*

专业领域 Area of Profession

职业 Occupation*

通讯地址 Correspondence Address*

州/省/区域 State/Province/Region

市 City*

州 State*

邮政编码 Postcode*

国家 Country*

个人照片上载 Photo Upload*

正面照 Front Portrait Photo

戒牒照片上载 (出家证) Ordain Certification Upload

正面照 Front Portrait Photo

请求、关切和/或咨询 Requests, Concerns and/or Inquiries

紧急联络人姓名 1 Emergency Contact Name 1*

关系 1 Relationship 1

联络电话 1 Contact Number 1*

紧急联络人姓名 2 Emergency Contact Name 2

关系 2 Relationship 2

联络电话 2 Contact Number 2

禅修方法 Type of Meditation Practice*

禅修老师 Meditation Teacher

你是否曾经在任何法域道场（或兜率天修行林）修行过？Have you practiced at any Dhamma Earth monastery or Tusita Hermitage in the past?

是 Yes

否 No

如果有，请简述何时，多久与向哪一位禅师学习。 If so, please give a brief description of when, the duration, and under which Teacher(s) guidance.

你是否有较严重的疾病？Do you have any significant physical health ailments or conditions? *

是 Yes

否 No

如果有，请告知你现在的状况和药物，以及病史及治疗状况。 If so, please give details of your present condition / medication, the condition’s history and treatments *

你现在是否有任何精神方面的疾患，如忧郁、焦虑、歇息底里或其他？ Do you currently have or in the past had any mental health conditions such as depression, panic attacks, hysteria, etc.? *

是 Yes

否 No

如果有，请告知你现在的状况和药物，以及病史及治疗状况。If so, please give details of your present condition / medication, the condition’s history and treatments *

最近3年以来，你是否有饮酒及服用毒品及任何麻醉品？Have you ever used any alcohol, drugs, or any other intoxicants in the past 3 years? *

是 Yes

否 No

如果有，请告知现在及以前的状况，毒品的类型，是否成瘾，及治疗状况。If so, please give details of present and past usage, types, addictions, treatments, etc. *