Retreat Application Retreat Application Please enable JavaScript in your browser to complete this form.Applying for Retreat date:NameAddressDate of BirthOccupationEmail *EmailConfirm EmailBest Contact Numberbackup Contact NumberGenderMaleFemaleEmergency Contact (Name)Emergency Contact's NumberHave you prevously attended a course at Bodhi Tree?YesNoIf you answered 'Yes', please provide details.How did you find out about Bodhi Tree?FriendBuddhanetBuddhist OrganisationTelephone DirectoryPoster/FlyerOtherPlease specifyWould you like to recive relevant news and updates via Email? (we promise not to spam or share your address with Third Parties).YesNoI am able to offer someone a lift to and from the Retreat.YesNoBy ticking 'Yes', you consent to our releasing your details to retreatants in need of transport. Please detail any prior meditation experience, including teachers, if relevant.Please detail any physical or psychological conditions that need to be taken into account.Are you seeing a Mental Health professional?YesIf 'Yes', do they approve of your participation in this course?NoMental Health practitioner's Name.Mental Health practitioner's Contact Number.Are you taking any prescribed medication?YesNoPlease provide details.PhoneSubmit 2020-01-10
