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Summer Service Retreat 2019 -Application Form
Welcome to the Summer Service Retreat at the Upper Hamlet 2019. Please fill out the form below and be aware that we cannot consider your application form if you have not been to Plum Village or one of our practice centres before. We ask for your patience as it might take us a few weeks to get back to you. For more information please write to us at the following address :

Bienvenue à la retraite de service d’été au Hameau du Haut 2019. Veuillez remplir le formulaire ci-dessous et sachez que nous ne pouvons pas prendre en compte votre formulaire de candidature si vous n'avez jamais été à Village des Pruniers ou à l'un de nos centres de pratique. Nous vous demandons votre patience, car il nous faudra peut-être quelques semaines pour vous répondre. Pour plus d'informations, écrivez-nous à l'adresse suivante: Veuillez remplir ce formulaire si vous souhaitez écrire en français:

Add a Photo of you *
First Name *
Last Name *
Gender *
Date of Birth *
Email Address *
First Language *
Other Languages Spoken
Address/City/Country *
Mobile Nr. (Landline if no mobile) *
Emergency Contact (Name, Telephone Number, Relations) *
Have you received the 5 or 14 Mindfulness Trainings or are you a lay Dharma Teacher?
Your profession or occupation *
Work Responsibilities
Please indicate below your preference for a work responsibility as well as the experience and qualities you have for your preferred role. We ask you to be flexible to the needs of the Sangha as we will not necessarily be able to offer you your preferred role.
I would like to participate in the following program: *
Please check all the ones you are interested in.
Past experience of related service and relevant skills/qualities
Translation Skills (if applicable)
Have you previously volunteered with us? *
If you answered "Yes," in what capacity did you serve as a volunteer?
Name of one Plum Village monastic who knows you and can act as a reference
Do you attend a local Sangha or other community in the Plum Village tradition of practice? If yes, please give details
Which retreats in Plum Village or in the other Plum Village practice centres have you been on in the past? *
What are your motivations for volunteering? *
Are you planning to bring any children or other dependents that you will need to care for during the retreat? *
Do you have any physical, emotional or psychological limitations, which may affect your ability to work? If yes, please give details (What is your current situation or diagnosis, with doctors letter if possible) *
Are you taking prescribed medication for physical or psychological reasons? Please write down the name of your medication and what it is for (If No, Please type "No" ) *
Statement of Aspiration
Please let us know a little about yourself, including any important information that will help us to better facilitate your stay.
I confirm that: *
For children’s program volunteers:
Liability Waiver
I, the undersigned, am aware that I am responsible for my own health and well-being during my stay at Plum Village, and that the Monastery cannot be held responsible for any accidents or injuries that may befall me. I understand that meditation is a complement to, and not a substitute for any physical, psychological or emotional medical treatment.
I understand that I am fully responsible for my personal belongings that I bring to Plum Village, and I release the liability of any damage or loss that may happen to my personal belongings.
Please type your legal name here in agreement *
Date of Signature *
Place of Signature *
Thank You!
We will get back to you as soon as we can regarding your application. Please be patient as this may take some time.
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This form was created inside of Plum Village Community of Engaged Buddhism. - Terms of Service