Retreat Cabin Rental Application

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Emergency contact name and number*

Select a preferred check-in and check-out date for you retreat. NOTE: Check-in and check-out must be on a Saturday. Maximum duration of retreats is currently twelve weeks. Minimum is one week. *

Briefly describe any conditions that may limit your ability to be in retreat. *

Have you received pointing out instructions with Tsoknyi, Mingyur or Tulku Urgyen Rinpoche or another qualified Dzogchen or Vajrayana master? (If not please contact the retreat cabins coordinator before completing the application.) *

If you have received pointing out instructions from a Dzogchen/Vajrayana master other than Tsoknyi Rinpoche, please list the name of that teacher.

Why do you want to do solitary retreat? *

How long have you been practicing dharma? *

List the solitary retreats you have done in the past:*

Please tell us a little about your daily personal practice: *

What is your retreat facility preference? Check all that apply.*

Yeshe Rangsal HouseRetreat Cabin

Have you ever lived alone where you were completely self-reliant? If so please explain. *

Have you spent time in a relatively remote area for long periods of time? Are you afraid of the dark or wildlife?*

Can you plan your meals so that shopping occurs at most once a week? *

What is the thing that most concerns you about doing this retreat?*

Is there anything else that you would like us to know about you?

Would you be okay if gardening or landscaping happened outside your cabin or Yeshe Rangsal House while you are in retreat?

Yes, I don't mindNo, I would find this disturbing

Have you read the Retreat Information on the Pundarika Website? See Click here*

Yes I have read the Retreat Information on the Pundarika website.

Have you read and do you agree to the terms and conditions of the Retreat Agreement and Waiver and Release documents. Click here to sign the waiver.*

Yes, I have read and I agree to the terms and conditions and understand that I will need to sign a Waiver and Release form after registration.