3-Day Retreat at POP House
It is important for us to ensure that our meditation retreat environment will serve you well. To that aim, please answer each of the questions below.
Email address *
Retreat Date *
PERSONAL INFO
Gender *
Full name *
Your answer
Nationality *
Your answer
Birth of Date *
MM
/
DD
/
YYYY
Current Address *
Your answer
City, Province / State, Country. *
Your answer
Emergency Contact: *
Your answer
Emergency Contact Phone Number. *
Your answer
MEDITATION BACKGROUND
Have you ever meditate before? *
Meditation experiences
If you check (YES) please describe it here.
Your answer
FOOD
IMPORTANT: The Middle Way Meditation Retreat is Non-Vegetarian Retreat. In case you are vegetarian and would like to join the retreat, we will prepare some vegetarian food for you, please answer the question below and let us know what you cannot eat such as: eggs, dairy products, fish source, etc *
Do you have any food restrictions, allergies, or environmental health concerns?
Your answer
Health Condition
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 info@mmipeace.org. If you have any mental illness or are on any mind-affecting drugs please leave any pertinent information in the space below. *
Your answer
Do you have any health issues that may affect your ability to attend a meditation retreat? *
Your answer
PAYMENT
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? *
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 and activities, 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 or activities. *
In further consideration of being permitted to participate in the retreat, I knowingly, voluntarily, and expressly waive any claim I may have against representative of the Middle Way Retreat 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 any activity held at the Middle Way Retreat 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. *
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