Retreat Application Form (Skiptvet Forest Monastery)
2024 edition: 22 to 30 June

Please be advised this information is strictly confidential and will be deleted after the retreat.
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Full name with title (Mr/Mrs/Ms/Dr/other) *
Phone number *
Email *
Date of birth *
MM
/
DD
/
YYYY
Emergency contact *
Please write their relationship to you, name, and means by which they can be contacted
What is your occupation? *
What is your first language? *
Do you speak English? *
Have you practised meditation before? *
If you have answered Yes to the question before, please briefly summarize your meditation experience
Do you have a daily meditation or yoga practise? *
If you have answered Yes to the question before, please give us more details about your daily practise
Do you have any physical difficulties or medical condition that it would be helpful for us to know about?
 *
If you have answered Yes to the question before, please describe your condition(s)
Do you have any history of mental illnesses?
 *
If you have answered Yes to the question before, please describe your history of mental illnesses
Do you currently take any medication?
 *
If you have answered Yes to the question before, please describe the said medication(s)
If there is anything else that seems important for the teacher to know, please write it down below
For example: recent bereavement, family difficulties, history of abuse, experiences of heavy recreational drugs (e.g. heroine, LSD or DMT), attempted suicide, depression, stress at work, etc.
Why do you want to join this retreat?
 *
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