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Satipatthana Meditation Society of Canada

  • 1.
    Personal
    Information
  • 2.
    Additional
    Information
  • 3.
    Most Recent
    Meditation Retreats
  • 4.
    Meal and Medical
    Information
  • 5.
    Policy, Agreement
    and Submission

Online Application Form for the Meditation Retreat

It is essential to have previous experience in Mahasi Meditation Method and to strictly adhere to the 9 precepts and retreat schedule. Signed applications need to be received before coming to the centre. Final acceptance and approval by SMSC required. (If you have no access to sign on-line, you may sign on arrival to the Retreat Centre).

1. Personal Information

Gender

2. Additional Information

Request retreat period
Emergency Contact
Describe your previous retreats (up to five) including Type, Teacher, Location, date and duration for each retreat.

3. Meal and Medical Information

Please answer a few more questions about meals and medical insurance so that we can provide you best based on your needs. All fields are mandatory.
Are you Vegetarian?
Do you have food or other allergies? If yes, please specify.
Do you have BC or any other type of health insurance? Please specify type of health insurance.(It is imperative to have health insurance.)
Do you have any physical or mental health issue(s) SMSC need to know about?
If yes, please specify

4. Policy and agreement

Please read this carefully before you submit this form online.
1.
I agree to abide to the following rules and structure :
- Practice Mindfulness-Insight (Mahasi Tradition) only
- Strictly adhere to the Nine Precepts
- Maintain Noble Silence
- Slow down all actions and behavior at all time
- Follow the retreat schedule
- Anyone who becomes a disturbance to the retreat will be asked to leave
2.
I am aware that I may be photographed or videotaped at the retreat for sharing among SMSC participants, yogis and SMSC dhamma friends.
3.
I agree to allow my personal information to be kept on file with the SMSC.
If you select "No", you will need to fill out this form at each future retreat you attend.
BY SUBMITTING THIS ELECTRONIC APPLICATION I AGREE TO WAIVE ALL FORM OF LIABILITY TOWARD THE SMSC, ITS STAFF AND VOLUNTEERS FOR THIS RETREAT AND ALL OTHER RETREATS I WILL BE ATTENDING WITH THE SMSC.