General Registration Form

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This field is for validation purposes and should be left unchanged.

Name(Required)

First and Last

Date of Birth(Required)

Email(Required)

Phone(Required)

Which event are your registering for ?

Emergency Contact Information #1:

Emergency Name #1(Required)

Relationship(Required)

Emergency Phone #1(Required)

Phone

Emergency Email #1(Required)

Emergency Contact Information #2

Emergency Name #2(Required)

Relationship(Required)

Emergency Phone #2(Required)

Phone

Emergency Email #2(Required)

Medical History:

Do you have any medical conditions or allergies we should be aware of? If yes, please specify.(Required)

Considerations for Mental Health(Required)

As a non-professional, volunteer-based organization, we are not equipped to provide the specialized care that such circumstances may require. While meditation offers profound benefits for many, it is not a replacement for medical or psychiatric treatment. For these reasons, we advise those with serious psychiatric conditions to prioritize professional care and ensure they are in a stable position before considering this practice.

Do you feel that your intentions and capacity align with the expectations of this event?

Yes, my intentions and capacity align with the expectations of this retreat.

Guidelines/Schedule/Info(Required)

Declaration: Have you carefully read and fully understood the guidelines outlined in this registration form and all other information provided? By clicking “Yes” below, you acknowledge that you have reviewed, understood, and agree to abide by these guidelines and the accompanying information.

Yes

ASSUMPTION OF RISK(Required)

I understand that participation in this overnight meditation event at Sangha House NOLA (the “Temple”) involves physical activities including prolonged wakefulness, sitting, standing, and walking meditation for extended periods of time, general use of Temple facilities and equipment, and the presence of other participants. I acknowledge that this is a silent overnight meditation event. I agree to act with reasonable care and follow all posted and verbal safety instructions. I am voluntarily participating in these activities with full knowledge of the potential risks involved and hereby agree to accept any and all risks of harm that may result from participation. I am responsible for my own health and accommodations. I will inform Temple staff of relevant safety or access needs before participation. If I have allergies or conditions affected by incense, candles, or food, I will notify staff. If you agree, please sign below with your digital signature (first and last name typed). If you agree, please sign below with your digital signature (first and last name typed).

KNOWING AND VOLUNTARY EXECUTION(Required)

I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between myself and Traveling Nunk, Sangha House NOLA, Venerable Clear Grace Dayananda, any residents, members , or participants thereof, property owners, and/or its affiliated organizations. I sign this agreement of my own free will.

If you agree, please sign below with your digital signature (first and last name typed).

Do you consent to being photographed or recorded during Sangha activities for Impact purposes?(Required)

Yes, you may record and or share my image

No, please don’t record or share my image