Samadhi Center- Pre-registration Form 2018
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
Email Address *
Your answer
Sex *
Required
Which Samadhi Center retreat do you want to sign up for? *
Required
We do our best to accommodate your preferences. You will be notified if your choice is not available. I would like my accommodations to be in: *
Home Phone: *
Your answer
Address: *
Your answer
City, Province/State, Country: *
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) *
Each day participants contribute "seva" or "selfless service" to the operations of the center. Please select the job(s) for which you are best suited. *
Required
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 seva 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 seva 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 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 any activity 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. *
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