Name
*
First Name
Last Name
Gender
*
(For purposes of accommodation assignment.)
Age
*
Email Address
*
Home Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
Your phone number
Country
(###)
###
####
Emergency Contact Details
*
Please provide details for someone we can contact in case of emergency.
Emergency Contact Person's Name:
First Name
Last Name
Emergency Contact Person's Phone Number
Country
(###)
###
####
Relationship of this person to you (parent, spouse, roommate, etc.):
If required, can this person arrange for your transportation back from the monastery?
Will you have health insurance coverage for the duration of your stay?
*
Why would you like to stay at the monastery?
Have you read through the document: “Information for Guests Staying at Temple Forest Monastery”?
Are there recent circumstances (e.g. loss of a loved one, illness, substance abuse, prolonged depression) or past history (e.g. attempt to take your life) that might affect your stay?
Do you have any history of mental illness or disorders?
*
If yes, please describe:
Are you currently taking any medications?
*
If so, please describe:
Do you have any physical limitations that would prevent you from participating in the daily work period?
Please describe briefly any prior meditation experience.
Have you stayed at a Theravada Buddhist monastery before?
If so, please describe where, when, and for how long.
Any further comments you’d like to share?
Please indicate when you would like to visit.
