Solitary Retreat Application

Personal Retreat Application

Karmê Chöling Meditation Retreat Center, Barnet, VT
Prerequisites for doing any independent in-house retreat are:
- You must be a member or friend of Shambhala;
- Completion of at least one week of silent, group sitting meditation retreat
- Established daily meditation practice of at least one year;
- The ability and discipline to do a self-directed meditation retreat
- A written recommendation from a meditation instructor or senior teacher
- Meeting with your meditation instructor to discuss and form retreat plans
Questions? Contact the Personal Retreat Coordinator
Name*

First NameLast Name
Are you vaccinated against COVID-19*

YesNoPartial
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
I would rather be contacted by:*

EmailPhone
Have you been to Karmê Chöling before?*

YesNo
What is your motivation for doing a personal retreat at Karmê Chöling?*
Have you attended a group retreat at Karmê Chöling before? If so, when?*
If you haven't done a group retreat at Karmê Chöling, have you done one elsewhere?
If yes, please list when and where. List all the retreats you have done.
What practice will you be doing during this reatreat?*
When would you like your retreat to begin?*

MonthDayYear
Date
When would you be leaving retreat?*

MonthDayYear
Date
Accommodations
For more details about retreat accommodation options, visit our Accommodations page.
What is your first choice for accommodations?*
What is your second choice for accommodations?*
Meditation Instructor Contact Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
They would rather be contacted by:*

EmailPhone
Are you a member of a Shambhala Center or Group?*
What is the name of your Shambhala Center or Group?
Care & Conduct Policies

All participants and staff are required to follow our COVID Policy and our Code of Conduct. Please read these documents carefully.
COVID Policy*

I have read and agree to follow the COVID-19 procedures.
Code of Conduct*

I have read and agree to follow Karmê Chöling's Code of Conduct.
What kind of diet do you have?*

VeganVegetarianOmnivoreGluten-freeDairy freeOther
Do you have any dietary concerns or special dietary needs?
Please include food allergies!
Do you have any mental or physical health concerns that you would like to share with us?
How can Karmê Chöling support you in this regard? How are you supporting yourself?
Do you have any questions for us?
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Personal Retreat Application

Prerequisites for doing any independent in-house retreat are:

Accommodations

Meditation Instructor Contact Information