Residential Retreat at Whispertree

Thanks so much for registering for this retreat. We're delighted you'll be joining us!

In addition to your basic contact information, we ask about your practice background, as well as about your personal health. Intensive retreat practice can be physically and psychologically challenging. To support you in those rare cases when difficulties do arise, responses to these questions will help us respond to the situation more effectively. We respect your privacy and your answers to these questions will be read by the teachers of this retreat only, and your responses are confidential.

In an effort to support our health and safety, please be sure you are healthy and free from COVID-19. Please perform a self-test within 24 hours of the start of the retreat.

During the course of the retreat, we may offer small group practice and/or private meetings with teachers. These meetings are for the purpose of supporting your practice during the retreat and are not to be construed as a form of psychotherapy or counseling. They are a valuable time to gain insight into practice through the process of shared discussion.

Thank you, again, for taking the time to answer these questions. By registering for this retreat, you are stating that you understand the nature of this program. You hereby release the Retreat Center and Pacific Mindfulness, its officers and staff from any liability in the event of an accident or injury occurring while participating in the program. Additionally, you agree to be added to the Pacific Mindfulness mailing list and receive email and/or newsletters from Heidi Bourne and Pacific Mindfulness. Your information will never be shared or sold.

Name *

Address *

Email Address *

Phone Number *

Preferred Pronouns

Emergency Contact with Phone Number *

Medical Emergencies *

In case of a medical emergency, if necessary, may we consult with your medical doctor? If yes, please provide your medical doctor's contact information.

Allergies *

Do you have any allergies we should know about? If yes, please describe.

Food Restrictions *

Please let us know if you have any food restrictions/allergies (not optional preferences) that are necessary to your health.

Do you have any physical illness or limitations that may interfere with gentle movement, sitting or walking practice? Participating in a retreat at Whispertree Retreat requires the ability to walk about a half mile up and down a gentle hill on a gravel road or a well-maintained trail several times each day. If this interferes with your ability to attend this retreat, please be in touch with us so we can try to accommodate your needs. *

Are you taking any prescription medications that would be important for us to know about? *

What motivates you to attend a retreat at this time? *

Meditation Experience *

Please describe your experience with meditation. What kind, how long, etc.

Retreat Experience *

Is this your first residential meditation retreat? If not, please describe your previous retreat(s).

Are there any additional comments or information you would like to convey to the teachers?

Please Indicate Lodging Choice: *

How did you hear about this retreat?

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