Retreat sign-up

Name(Required)

First name Middle name Last name

Email address(Required)

Add email address Confirm email address

Phone number(Required)

Date of birth(Required)

Meditation experience(Required)

Do you have experience with meditation of did you follow a mindfulness- or compassion training? If so, please give a brief description of your experience.

Retreat experience(Required)

Did you participate in a retreat before? If so, please give a brief description of how long, when and the name of the teacher(s).

Motivation to participate(Required)

We like to hear a bit about your motivation to participate.

Physical impairments(Required)

Do you experience a physical illness or any other impairment that make sitting, standing, walking or executing simple exercises difficult for you?

Necessary provisions(Required)

Are there any special provisions necessary for your participations? If so, please specify.

Mental health(Required)

Are you currently experiencing mental health problems that affect your daily life and that you experience as stressful?

If yes, you could think of:

Please check the appropriate boxes.

Anxiety

Uncertainty

Fear/panic

Depression

Melancholy

Burn-out

Judging yourself

Feeling of inner chaos

Rumination

Worrying

Other, f.e..:

Please describe, if applicable.

Under treatment(Required)

Are you currently in (psycho)therapy or have you been in the recent past? If so, please contact us to discuss whether this retreat is suitable for you.

Dietary requirements and food preferences

If applicable, please specify your dietary requirements. All our food is vegetarian.

My responsibility as a participant(Required)

I sign up for the aforementioned retreat period and resolve to adhere to the retreat rules as much as possible. I know that if I can't or don't want to do certain exercises - for whatever reason - I'm under no obligation to do them. I also know that I cannot hold the supervisor responsible for injuries resulting from these exercises.

I agree

Prijs (verborgen)

Total amount

Payment

We ask you to pay for the event here. You will be redirected to Mollie, our payment provider. Please choose a payment method and click send.

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