Mindful Backpacking Retreat - Make reservation

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Reservation details

Retreatant First Name*
Retreatant Last Name*
Retreatant Age*
Retreatant Date of Birth*
mm/dd/yyyy (four-digit year)
Retreatant Gender*
Registration Agreement*
Check the box above if you agree to make a total registration payment of $600 to complete registration if your application is accepted.
Sliding-Scale Contribution
Our standard registration fees are set at a reduced level to make retreat attendance more accessible. If you are able to contribute additional funds to your $600 registration fee, it will help us offer financial assistance to those in need. The contribution selected will be added to your registration fee once. Thank you.
Attended Plum Village Tradition Retreat
Check the box above if you have attended at least one Plum Village Tradition retreat led by monastics. Attending such a retreat is not a requirement for participants.
Recent Retreats Attended
If applicable, please list recent retreats you have attended.
Sangha and Practice Experience
If applicable, briefly describe your Sangha and practice experience, including Sanghas you have attended and dates, as well as Sangha activities and organizational roles.
Self-Sufficiency for Backcountry Trip*
Have you been self-sufficient on at least one 5-day backpacking trip in a wilderness area?

Preparing Meals with Camping Stove*
Have you prepared meals for yourself using a camping stove?

Equipment and Food*
Do you agree to be responsible for all of your own equipment and food?

Wilderness Travel Responsibility*
Do you understand the risks and responsibilities of wilderness travel, including personal safety; protecting land, water, animals, and plants; and handling of human waste (i.e. do you know how to relieve yourself in the woods using Leave No Trace principles)?

Wilderness Experience*
Briefly describe your wilderness experience, including dates, lengths of trips, number of people, leadership and organizational roles, and training received.

Mindfulness Trainings

Have you received the Mindfulness Trainings?
Please note that previous Mindfulness Training is not required to attend the retreat.
Dharma Name
If you have been given a dharma or lineage name, please enter it here.

Medical Information

Physical Health History
Please describe any ongoing medical conditions you may have and any medications you take for your physical health.
Mental Health History
If you have been diagnosed with a psychiatric or psychological condition, please explain and list any medications you take for mental health.
Doctor's Name
Doctor's Telephone Number
Liability Waiver*
By checking the box above, I and all parties on this application relieve Deer Park Monastery from all liabilities in the event of any injury or illness incurred during the retreat.

Billing Details

Emergency Contact

Name of Contact*
Please give us the name of an emergency contact who is not attending the retreat. This person will only be contacted in the event of an emergency.
Relation to You*
Telephone Number of Contact*
Language of Contact

Additional info

I agree to the Cancellation Policy*
For registration cancellations made on or before July 13, 2024, partial refunds will be available with a cancellation fee of $60 per person. Cancellations made on or after July 14, 2024 do not qualify for a refund. Registration is non-transferable.
May we keep in contact?*
Please click on the drop-down arrow to select yes or no. We would like to keep in touch with you, to nourish you with news about the Plum Village tradition practice and community. We will keep your information safe and secure and we won’t share it with other organizations. You will always be able to unsubscribe easily through a link at the bottom of our e-mails. For further details on how your data are used and stored, please visit: https://deerparkmonastery.org/privacy-policy/
Retreat at Monastery
Is this your first time attending a retreat in the Plum Village Tradition?
Special registration code
If you have received a special registration code, enter it here.
Notes
Enter additional notes here.

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