Self Retreat Application

Thank you for your interest in the WDC Self Retreat Program.
*Check- in begins at 3 pm (If you would like to check in early, please contact us. Additional donation of $20 is appreciated for your lunch at 12pm.
*Check-out from room 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.

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

Name

Address (City, State, Zip Code)

Phone Number

How do you identify your gender?

Date of Birth (MM/DD/YYYY)

How did you hear about the Won Dharma Center?

What are your expectations of your stay here?

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

I have carefully read this LIABILITY WAIVER and fully understand its contents. I am aware that this is a release of liability and contract between myself and WDC and its affiliated organizations. I will sign it of my own free will upon my arrival at the WDC.(required)

Yes