In order to attend the program you must be willing to commit to the eight week course of  two hours  per week and a one day retreat, this is not a drop in class and will include home practice of 15 to 30minutes per day. You will get the most from the course if you are able to offer this commitment and you will be supporting fellow participants.

Please be sure you have read the course information before completing your application. If you have any questions or concerns about whether this is the right time for you to do the course, please contact me

Amaranatho may contact you before the orientation session. Very occasionally we consider that the time is not right for an individual to attend the course

There will also be a audio guided meditation available for home practice. The course has element of working with the body including stretching and can be done with respect to how your body is. You might find this website for some background information on mindfulness.

Please have a look at the form before filling it in – it requires a lot of information and the form cannot be saved.

Registration Form and information – Strictly Confidential

When you fill in this registration form you are agreeing to accept full responsibility for your choices and experiences and release Amaranatho from all liability for such.

Amaranatho is not a licensed psychologist or mental health provider and his services are considered complementary to normal medical and psychiatric care. Please discuss medical or psychiatric concerns with your physician or mental health provider. You are attending the workshop with the above understanding.

 

 

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Your Details

First Name:*

Last Name:*

Mobile Phone number*

Email:*

Gender:*
Male
Female

Date Of Birth*

Emergency Contact Details

Who should the retreat organizer contact in case of an Emergency

Name of Person to contact in Emergency*

Emergency Phone Number*

Have you practiced mindfulness before or any other body/mind techqniues? Have you been on retreat before? If Yes Briefly describe where, when, etc.

Do you have any physical difficulties or medical condition that would be helpful for us to know about?:

Have you had – or do you currently suffer from – any form of mental illness?

If you are currently receiving counselling, psychotherapy or any mental health treatment please tell your therapist that you are undertaking the course.

Are you currently taking any medication? If you are what kind of medication?

Do you have any allergies?
Allergies to anything, including food, medicine, insects, animals leading to anaphylaxis

Anything you would like to share regarding your personally circumstances

Sometimes things happen to people that are extremely upsetting – things like being in a life threatening situation like a major disaster, very serious accident or fire; being physically assaulted or raped; seeing another person killed, dead, or badly hurt, or hearing about something horrible that has happened to someone you are close to. At any time during your life, have any of these kinds of things happened to you?

I appreciate sharing about sexual abuse maybe difficult for you and if this has happened to you please let us know in away that is helpful for both of us.

If this does not apply please write NA

Please do let me know if anything extremely upsetting happens just before the course starts

Can you commit to the six week program and the one day retreat*
Yes
No

I declare that all information provided is true and correct*
Yes
No

CAPTCHA Code:*

 

Data Protection Act: Your contact details may be kept, but no other personal information will be maintained on file – all details will be destroyed after the retreat/course/workshop. Your details will not be shared with any other person or organization.

Cancellation Policy

There are no refunds one week before course starts or if you have to leave the course (it maybe possible to use this for another course), otherwise admin fee of 50 Euros.

Please note:
This course is taught in English only