Hridaya Yoga
49-Day Individual Silent Meditation Retreat Application

Please complete this application fully and return it along with a recent photo to .

Date of retreat you are applying for:

First name: Family name:

Nationality: Birth date (dd/mm/yyyy):

Gender (F/M):Email: Phone:

Address:

EMERGENCY CONTACT

Please provide the contact details of someone you authorize to make decisions on your behalf in an emergency. This information will be kept private and only used in case of a crisis affecting your health and well-being.

Full name: Relationship:

Phone: Email:

DIETARY NEEDS AND MEDICAL RESTRICTIONS

1. Please specify your dietary restrictions, if any:

2. How many Hridaya Silent Meditation Retreats have you done before?

3. How many other meditation retreats (if any) have you done before? Please describe the kind of retreat and length of time.

4. Which was your longest period of solitude (mauna, stillness)?

5. How many hours do you meditate daily? Which style/tradition do you practice? (Be aware that during this 49-day Retreat the main spiritual practice will be Hridaya Meditation.)

6. How stable is your meditation practice (for how many months/years have you been meditating daily)?

7. What is your reason for doing this 49-day retreat? What motivates you?

MEDICAL STATEMENT AND QUESTIONNAIRE

An intensive meditation retreat may sometimes be physically and psychologically challenging. The Hridaya teacher is ready to support participants on those occasions when difficulties do arise. Having information regarding the following questions will help the teacher respond according to the specific situation.

Note: This information is kept strictly confidential. It is meant to inform Hridaya staff of any limitations or special conditions.

Please make an “X” on the line if the following medical conditions apply and give a brief description of your positive response:

___If you are a woman, could you be pregnant?

___Asthma/difficulty breathing?

___Any form of lung disease?

___High cholesterol?

___High blood pressure?

___Have you undergone major surgery, especially on the spine, skull and abdomen?

___Bleeding or other blood disorders?

___Back, arm or leg problems following surgery, injury or fracture?

___A head injury with loss of consciousness in the past 5 years?

___Recurrent back problems?

___A back or spinal injury?

___Diabetes mellitus?

___Frequent allergies?

___Blackouts or fainting?

___Recurrent migraine headaches?

___Behavioral health, mental or psychological problems or borderline conditions (depression, schizophrenia, paranoia etc.)?

___Recreational drug use or treatment for addiction?

___Epilepsy, seizure or convulsions?

___Any recent injury, even if you feel 100% recovered?

___Are you currently taking medication for any physical or psychological condition? If so, specify the condition, and list the medication and dosage.

Is there anything else you would like Sahajananda to know before you enroll in this 49-day retreat?

Additional comments:

NOTE:

  1. Please take into consideration that the participants should not smoke or take recreational drugs or illicit substances.
  2. This Hridaya 49-Day Retreat requires wisdom, determination, and surrender. It is very important to follow all the advice (about both spiritual and practical issues) coming from Sahajananda and the other Hridaya teachers who assist you.
  3. For your spiritual life it is important to keep your commitments. Meditate about this beautiful possibility in your spiritual life, see how you feel about it, and when you decide to do the 49-Day Retreat, firmly keep your commitment.
  4. To prepare for this retreat, Sahajananda recommends2 hours of Hridaya meditation daily.

By typing my full name and making an “X” on the signature linebelow, I attest that the information provided on this application form is true and complete.

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