Samadhi Center- Pre-registration Form
It is important for us to insure that our meditation retreat environment will serve you well. To that aim, please answer each of the questions below.
Full name: *
Your answer
*
Required
Which Samadhi Center retreat are you interested in attending? *
Required
I would like my accommodations to be in: *
Email Address: *
Your answer
Cell Phone: *
Your answer
Home Phone: *
Your answer
Address: *
Your answer
City: *
Your answer
Emergency Contact: *
Your answer
Emergency Contact Phone Number: *
Your answer
We usually send a Paypal invoice which you can pay with any credit card, bank account, Paypal account or e-check. Would you like us to send you a Paypal invoice to secure a place in the upcoming retreat? *
Do you have meditation experience (please describe): *
Your answer
Do you have any health issues that may affect your ability to attend a meditation retreat? *
Your answer
Although meditation is helpful for most people, it is not a substitute for medical or psychiatric treatment and we do not recommend it for people with serious psychiatric disorders. If you are unsure whether a meditation retreat is right for you please contact us at contact@samadhi.ca. If you have any mental illness or are on any mind-affecting drugs please leave any pertinent information in the space below. *
Your answer
The bunk beds can safely support persons of up to 200lbs. Is your weight over 200lbs? We will try to accommodate accordingly. *
Required
Do you have any food restrictions, allergies, or environmental health concerns? *
Your answer
Do you have any concerns about being in silence for the duration of the retreat? *
Do you snore? (We try to adjust the dorms accordingly) *
Are you willing to provide a ride to other participants from your city? *
Your answer
Do you need a ride from your city? *
Your answer
LIABILITY WAIVER
I am participating in classes or services during which I will receive information and instruction about meditation. I recognize that I may also choose to do physical movement, such as stretching, walking and yoga. I represent and warrant that I have no physical or mental health condition that would prevent my safe participation in meditation classes. *
In consideration of being permitted to participate in the meditation classes, I agree to assume full responsibility for any risks, injuries or damages, known and unknown, which I might incur as a result of participating in the program. *
In further consideration of being permitted to participate in the meditation classes, I knowingly, voluntarily, and expressly waive any claim I may have against representative of the Samadhi Center, the class instructor, the owner, or the leaseholder of the building for injuries or damages that I may sustain as a result of participating in classes or workshops held at the Samadhi Center. *
I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. *
Submit
Never submit passwords through Google Forms.
This form was created inside of Awaken the World. Report Abuse