Land as Dharma Teacher (June)

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1 Welcome

3 Optional Items

4 Participant Info

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Are you a person who identifies as BIPOC (Black, Indigenous or Person of Color)? (optional)
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Birth Date (optional)	Knowing this helps us with housing assignments.
Do you have any physical health or mobility issues we should be aware of? *	If yes, please describe in the space provided. Please enter "no" otherwise.
Do you need to use a CPAP machine? *	If yes, please be sure to see very important CPAP information on our website under the Planning your visit Medical page. FURTHER, those using CPAP machines that are powered by electricity will be assigned to either casita 3 or 4, where we have solar batteries available. You must register for a CASITA if you plan to use your plug-in CPAP. If you bring your own rechargeable batteries or solar power source to run your CPAP then you may choose any lodging type.
Medically Necessary Dietary Requests	Gluten Free Dairy Free Lactose free Soy Free Egg Free Nut Free Vegan Vegan (with Honey) Specific Food Allergy (please explain below) Other (please explain below) If you have an allergy, please use the question below to adequately describe the nature of the allergy (for example, is the allergy anaphylactic?).
Diet Notes	Please explain any medically necessary dietary requests.
I verify that I have participated in at least 14 nights of residential retreats with authorized insight meditation teachers or the teachers have provided me with an exemption to this requirement. Please list your most current retreats that fulfill this requirement, we do not need your entire retreat history. *	Practitioners must have done at least 14 days of residential meditation retreat with authorized insight meditation teachers to be eligible. (It does not need to be 14 consecutive days in one retreat.) If you do not meet this criteria, we would be happy to help you find another retreat.
You will receive a practice discussion questionnaire two weeks before arrival. In the meantime, it is important for us to understand what supports you. Do you have any personal or psychological situations/diagnoses that would potentially require additional support or impact your retreat? *	If yes, please briefly describe the situation or diagnoses and how it might affect your retreat. Due to the remoteness of our center, this information will allow us to support your well being as fully as possible. Please enter "No" otherwise.
If you are a medical professional and would be willing to assist in the event of a medical emergency in our remote location, kindly note that here. (optional)
Emergency Contact Name *	Please include their relationship to you, e.g. sibling, spouse, parent, friend.
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Have you been to Vallecitos before?	Yes No
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Cancellation Policy *	I have read and understood the cancellation policy.CANCELLATION POLICY: 45+ days = full refund, less nonrefundable $150 fee; 45-22 days = 50% refund; 0-21 days = no refunds. Cancellation policy applies to all registered guests including scholarship recipients. For more detail visit our website here.
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