Please tell us about any special dietary needs that you have.
Do 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.
Do you have hearing loss (even mild) that sometimes requires assistance? If so please describe.
What 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?
What prescription medications are you taking now—or have taken in the past six months—for physical, psychiatric, mental health, or addiction issues?
Have you ever received inpatient care for psychiatric, mental health, or addiction issues? If yes, please describe:
Do 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?
Please describe your practice history and inspiration for attending this program.
Is there anything else we need to know about your registration?