Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
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Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How do you identify your gender?
Date of Birth
Occupation
Intended length of stay
Preferred dates of stay
Are you a Dharma Centre Member
Please give full details of your teacher(s), including teaching lineage and full contact details:
Please give details of your practice and list all conducted retreats (date, duration, solo or group, teaching style):
Please describe your current daily practice:
Please read the following section carefully: While many meditation practices are beneficial, some practices and retreat experiences may be powerful, negative, or disturbing, and not all retreats are suitable for every person. Those with mental illness or mental health concerns may have a particularly difficult time with some practices. If you are under the care of a doctor for a physical or psychological condition we recommend speaking to them about whether this type of intensive work is appropriate for you. If you have concerns or questions, please contact the Dharma Centre directly to be put in touch with the retreat instructor who can help you determine if this retreat is right for you. This information will be received by the retreat administrator and may be shared with the retreat teacher to determine suitability. This information will remain confidential and will be securely disposed of after your retreat. With the previous in mind:
Do you have any physical or mental health consideration you'd like us to know about?
Do you have any physical limitations that would prevent you from participating in the daily work period (generosity yoga)?
Please list any medical conditions (diabetes, high blood pressure, etc…) so that we may better understand your needs regarding this retreat:
Dharma Centre retreatants need to be self-sufficient and disciplined and maintain a steady schedule of practice. Please describe the method of practice you intend to follow, including your daily schedule of meals and meditation practice:
Have you encountered challenges in past retreats and if yes, please describe briefly the type of challenge and how you managed to resolve this matter:
Intensive meditation may affect how your body and mind interact with medications, herbal or other treatments. Please consider consulting your health care provider to determine any potential complications. If it is helpful to advise us regarding your medications/supplements — so that we can address any needs or circumstances that may arise — please list them and the daily dosage:
Thank you for registering for a solo retreat at the Dharma Centre of Canada!
Your retreat registration has successfully been submitted.
We will be in touch with you soon to confirm how to proceed with your application.
