* Practice history and InspirationPlease describe your practice history and inspiration for attending this program.
* Dietary RestrictionsPlease list any dietary restrictions, allergies, and intolerances. Please also indicate if exposure would require medical attention (i.e. anaphylaxis due to peanuts).
* AllergiesDo you have any serious allergies (e.g. bee stings, penicillin, nut allergies, etc.)? If yes, please specify and explain how we should best respond in the event of a medical emergency.
* Hearing lossDo you have hearing loss (even mild) that sometimes requires assistance? If so please describe.
* Medical conditionsWhat current or past medical or physical conditions are important for us to know about? Would any of this prevent you from doing chores during the program?
* MedicationsWhat prescription medications are you taking now—or have taken in the past six months—for physical, psychiatric, mental health, or addiction issues?
* Inpatient careHave you ever received inpatient care for psychiatric, mental health, or addiction issues? If yes, please describe:
* ConcernsDo you have concerns about engaging in intensive meditation practice at this time? Do others close to you (such as medical professionals, mental health professionals, or family members) have concerns?
Additional Comments Is there anything else we need to know about your registration?