Registration

For children below the age of 1 year, please enter 1.

mm/dd/yyyy (four-digit year)

If you attend a Sangha or meditation group, please write the name of the group in the space provided.

Why are you applying for a Contemplative Fellowship? Please tell us about your circumstances and how additional funding will make a difference in your ability to attend this retreat.

Have you received a Contemplative Fellowship from Deer Park Monastery this calendar year?

Are you requesting 50% or 75% fellowship funding?

How have you integrated contemplative practice in your personal and/or professional life? Are you following a specific spiritual path?

Do you identify as a member of the Black/ Indigenous/ People of Color community?

Do you identify as a member of the Lesbian/ Gay/ Bisexual/ Transgender/ Queer or Questioning/ Intersex/ Asexual/ Plus community?

Please describe any allergies you may have. Kindly note that we are unable to accommodate special diets and we do not have a cooking space for guests. If you are on a special diet, you may wish to bring some vegetarian food that does not require preparation to supplement your meals.

Please describe any ongoing medical conditions you may have and any medications you take for your physical health.

If you have been diagnosed with a psychiatric or psychological condition, please explain and list any medications you take for mental health.

By checking the box above, I and all parties on this registration relieve Deer Park Monastery from all liabilities in the event of any injury or illness incurred while visiting Deer Park Monastery.

Have you officially received the Five or Fourteen Mindfulness Trainings? Please select your answer from the drop-down menu. Kindly note that previous training or experience is not required to attend the retreat.

If you have been given a Dharma or lineage name, please enter it here.

Your emergency contact will only be notified in the event of an emergency.

By checking the box above, I agree to the following cancellation policy. For cancellations made prior to arrival day, partial refunds will be available with a cancellation fee of $10 per night for adults, and $5 per night for teens and children 6 years and older. Cancellations made on or after the retreat arrival day do not qualify for a refund. Registration is non-transferable.

By checking the box above, I acknowledge that I am applying to register for a mindfulness retreat. If accepted, I understand that I am expected to participate in the daily retreat schedule of the monastery and to practice according to the Five Mindfulness Trainings during my stay (please see our website for more info). I also understand that I am expected to remain on the monastery grounds for the duration of my retreat, unless I receive permission to leave and entry information to reenter. Further, I understand that, except in cases of emergency, I will not have access to monastery phones, computers, internet, or Wi-Fi, and that outside work, school, and family obligations must be set aside during my stay.

May we keep in contact? Please select your answer from the drop-down menu. We would like to keep in touch with you, to nourish you with news about the Plum Village tradition practice and community. We will keep your information safe and secure and we won’t share it with other organizations. You will always be able to unsubscribe easily through a link at the bottom of our e-mails.

Is this your first time attending a retreat in the Plum Village Tradition? Please select your answer from the drop-down menu.

Enter additional notes here.