RETREAT INFORMATION FORM for True Peace Sangha Retreat with Joanne Friday March 28 to April 1, 2012

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Please provide your name *

Please provide your first and last name

I have filled out the Retreat Registration Form & Liability Waiver and have included it with my payment to the retreat registrar *

I also understand that Dana (donation) to Joanne Friday will be in addition to the cost for accommodations.

Yes

Other:

Required

Gender *

(For room accommodations)

Female

Male

Other:

Required

Email address *

Please provide an email address where we can contact you regarding the retreat

Phone number *

Emergency Contact Person *

Please provide the name, relation and phone number of a person to contact in case of emergency

Room arrangements will be assigned, but please indicate any room sharing preferences in case we are able to accommodate them.

Please note: rooms will be assigned based on gender. Depending on attendence, we may or may not be able to accommodate opposite gender couples.

If you have mobility concerns or require an accessible room please indicate this here.

Sleeping cabins at the retreat centre do NOT have washrooms in them. Washrooms are a very short distance away at the main building/meditation hall. There may be one or two rooms available at the Sugar Ridge Bed and Breakfast that will have washrooms in the same building. If you require one of these rooms FOR HEALTH REASONS ONLY, please indicate this here.

For more information on accommodations please see www.sugarridge.ca. Please note, these rooms are up a flight of stairs and a ten minute walk or a minute drive away from the main building/meditation hall.

Will you be bringing an air filter or sleep machine for sleeping during the night?

Dietary Requirements or Allergies *

If none, please simply write "none"

Please share any tasks that would not be suitable for you for working meditation

ie physical restrictions, chemical allergies, etc

Please share any physical or mental health concerns you wish the retreat organizers to be aware of

You may also contact the retreat organizers directly if you prefer.

Please indicate if you have a vehicle and would like to offer a ride to the retreat

Please include number of seats available and a convenient major intersection. We will contact you further regarding ride sharing.

Please indicate if you do not have a vehicle and would appreciate a ride to the retreat

Please also include a convenient major intersection. We will contact you further regarding ride sharing

Have you ever attended a retreat in the tradition of Thich Nhat Hanh before? *

Yes

Other:

Required

Have you ever attended a meditation retreat before? *

Yes

Other:

Required

Do you practice regularly with a sangha? *

Yes

Irregularly

Other:

Required

Which sangha do you practice with? *

True Peace Toronto

None

Other:

Required

Please indicate which topics most speak to you in your life and practice at the moment. *

This information will be shared with Joanne to assist her in shaping the retreat.

Healing the Inner Child

Practising with Stress

Practising with Grief

Practising with Depression and Anxiety

The Practice of True Love

Practising with Attachment

Pride in Practice

The Practice of Changing the Peg

Watering Seeds of Joy

Helping the Environment and our World

Assisting the Sick and Dying

Balancing Committments and Practice

Practice in Everyday Life

Ethics and The Five Mindfulness Trainings

Healing Trauma

Family Practice

Resolving Conflicts

Finding Our Path in Life

Establishing a Solid Practice

Looking Deeply into Habit Energies

Healing the Past in the Present

Practising with Addictions

Mindfulness for Children

Practising at Work

Other:

Required

Please share briefly what you would like to learn about and practice at the retreat *

This information will be shared with Joanne to assist her in shaping the retreat.

Please share a bit about what is going on in your practice currently *

This information will be shared with Joanne to assist her in shaping the retreat.

Would you like to have the opportunity to formally receive the Five Mindfulness Trainings at the retreat? *

This information will be shared with Joanne to assist her in shaping the retreat.

I have already received the Five Mindfulness Trainings

Yes

Maybe

Other:

Please share any further comments.

This information will be shared with Joanne to assist her in shaping the retreat.

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