student name: ________________________ 中文姓名: _______________

　　grade年級: _______ sex性別: _____ phone電話: __________________

　　date of birth出生日期: ____ / ____ /________ (月/日/年) age年齡: _____

　　place of birth 出生地: ____________________________

　　address住址: __________________________________________________________

　　mother's name母親姓名: _____________________________ occupation職業: _________________

　　work phone公司電話: _____________________ home phone住家電話: _________________

　　address住址: ________________________________________________________________________

　　father's name父親姓名: ______________________________ occupation職業: _________________

　　work phone公司電話: _____________________ home phone住家電話: _________________

　　address住址: ________________________________________________________________________

　　child lives with學童和誰住在一起: 1) mother母 ____ 2) father父 ____ 3) guardian監護人 ____ (please state guardian's name, relationship to child and reason child has a guardian. 請注明監護人之姓名, 與學童之關系及需要監護人之理由.)

　　do the grandparents live in the family home with the child祖父母是否與學童住在一起 _______

　　number of brothers兄弟人數 ______ ages年齡 ______________

　　number of sisters 姊妹人數 ______ ages年齡 ______________

　　how many siblings does the child live together with與學童住在一起之兄弟姊妹有多少位 _______

　　religious faith of parents父母之宗教信仰: ______________________

　　does child embrace that faith學童是否也信仰該宗教 ___________

　　are the principles of religion discussed in the daily life of the family是否要求學童遵循該教之教義 _____

　　has the child had any buddhist instruction學童有否受過任何佛學教育 __________________