Self Retreat Application (updated)

Self Retreat Application

Thank you for your interest in the WDC Self Retreat Program.
*Check-in: 3 pm – 5 pm
*Check-out: by 12 pm
*Please read LIABILITY WAIVER carefully. You will be asked to sign this form upon your arrival.

Self Retreat Application Form

Once your applications have been received and processed, you will receive a confirmation by email.

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Thank you for your response. ✨

Retreat Dates: Please write arrival date (with approx. time) and departure date (with approx. time)

Room Type:

Name

Address (City, State, Zip Code)

Phone Number

How do you identify your gender?

Date of Birth (YYYY-MM-DD)

How did you hear about the Won Dharma Center?

Individual Meditation Instruction/Interview with the teacher: Our reverends offer hour-long interview/individualized instruction to anyone who wants to learn how to meditate and the Won Buddhist teachings. Do you want an individual interview with the teacher? (suggested donation: $20):

How many years have you been practicing? Any particular type of Buddhist Tradition?

Briefly describe any current physical problems or allergies that your feel the WDC staff should know about. Dietary Restrictions and Food Allergies: We can ONLY provide gluten, dairy-free options. We cannot accommodate all food sensitivities. If you have specific food sensitivity, you will need to bring your own food. A refrigerator for our guests is available in the Dining Hall.

Emergency Contact: Name

Emergency Contact: Relationship

Emergency Contact: Phone Number

Self Retreat Liability Waiver

During my stay at the Won Dharma Center (WDC), I understand that this is a self-guided personal retreat, and that I am not participating in a structured or staff-led program.
I understand that I may spend time in meditation, quiet reflection, light personal activities, and in the surrounding natural environment at my own discretion.

I acknowledge that my stay may involve certain inherent risks, including but not limited to physical injury, illness, allergic reactions, or accidents that may occur on the property or surrounding grounds, as well as risks associated with being in a rural setting, including hiking, uneven terrain, exposure to weather, and possible contact with plants such as poison oak, insects (including ticks), and wildlife.
I understand that I am fully responsible for my own schedule, activities, and well-being—physically, mentally, and emotionally—during my stay.

I agree to use the facilities and grounds with care, and to follow general guidelines provided by the Won Dharma Center.
In consideration of being allowed to stay at the Won Dharma Center, I hereby release and hold harmless the Won Dharma Center (WDC), its staff, volunteers, and affiliated organizations from any and all liability, claims, demands, or causes of action arising out of or related to my stay.
Acknowledgment

I have carefully read this LIABILITY WAIVER above and fully understand its contents. I acknowledge that this is a release of liability and a binding agreement between myself and the Won Dharma Center (WDC) and its affiliated organizations.
By checking this box and submitting this form, I am indicating my agreement to the terms above and that I am doing so of my own free will.
(required)

Yes