Form for Residential Meditation Retreat (Free) & Meditation Self Stay (Free)

** Please note that this program will be conducted exclusively in SINHALA Language until further notice.
Form for Residential Meditation Retreat (Free) & Meditation Self Stay (Free)

Fill out the form carefully for registration. The Program will take place at MBMM premises at Mount Evelyn and all meditators will be expected to abide by the rules and ways of practice normally followed in the monastery.
1. Meditator's Details:*

First NameMiddle NameLast Name
2. Gender:*
3. E-mail:
example@example.com
4. Mobile Number*
Format: 0000 000 000.
5. Phone Number

Area CodePhone Number
6. Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
7. How many family members will join you in meditation:
(For all family members, Please fill out a separate registration form)

No. of Male adults  *
No. of Female adults      *
No. of Children   *
7. Arrival Date:*

DayMonthYear
8. Departure Date:*

DayMonthYear
9. Are you intending to stay at the monastery during this period?
10. Emergency Contact 1:*

NamePhone Number
11. Emergency Contact 2:*

NamePhone Number
12. Are you ill, currently taking any medication or have a history of mental illness? If yes, please explain:
13. Have you participated in "SIL" programs or meditation programs conducted by Mahamevnawa? How many times?
14. Are you able to take care of your personal needs independently?*
15. If No, are you able to accompany an adult that will help you with your daily tasks? (The accompanying adult must complete a separate Registration Form)*
16. If you have any medical or dietary restrictions, please explain:
16. List the name of your therapist / Dr and their emergency contact telephone number:
Disclaimer:

Mahamevnawa Buddhist Monastery of Melbourne does not have public liability insurance cover for any injury or death or any loss of property suffered at the Meditation Program.

By submitting this form, I understand I waive my rights to sue “Mahamevnawa Buddhist Monastery of Melbourne” for losses relating to my/our death or personal injury that results from a breach of a condition specified in sections 91 and 92 of the Goods Act 1958. I acknowledge that I have carefully read the meditation policy, fully understood and fully agreed to stay on the premises and abide by the rules of the Mahamevnawa Buddhist Monastery of Melbourne for the duration of the meditation program.
Please verify that you are human*
Should be Empty: