SATI SARANIYA HERMITAGE
Please fill out this 'Request to Stay'. We will let you know via your contact email once it has been processed. If you don't hear back from us within a week, you can follow up by sending a message to hermitage@satisaraniya.ca
Sign in to Google to save your progress. Learn more
Personal Details
Please provide your ****LEGAL*** name  in the following two fields, if possible.
First Name *
Last Name *
Ordination Name (if applicable)
Contact Phone Number *
(###) ###-####
E-mail *
Street Address *
City *
Province or State *
Postal or Zip Code *
Country of Citizenship *
Emergency Contact Name *
Emergency Contact Phone *
(###) ###-####
Emergency Contact E-Mail
Accomodation
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Other Information
If you have stayed in a Buddhist monastery or religious community, where, when & how long? *
Put "N" if you have no previous experience.
Do you practice meditation? With what teacher / Sangha? *
Put "N" if you don't practice.
What, if any, special dietary needs or restrictions do you have? *
Put "N" if you don't have any needs or restrictions.
Are you able to keep the Eight Precepts? *
Do you have any special skills you would like to share during your visit?
For example: plumbing, sewing, carpentry, gardening, computer?
What, if any, physical or mental disability do you have? *
Put "N/A" if not applicable.
If you have previously or now suffer from anxiety/depression, please give details: *
Put "N/A" if not applicable.
What, if any, mood-altering drugs or medication are you taking? Are they prescribed? *
Put "N/A" if not applicable.
Traveling Arrangements
Preferred Date of Arrival *
MM
/
DD
/
YYYY
Approximate Arrival Time *
Preferred Date of Departure *
MM
/
DD
/
YYYY
Approximate Departure Time *
Are you coming by car or bus? *
Do you need a lift from Perth? *
Other Comments or Questions
Submit
Clear form
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.