Meditation the Essentials

Mandala Yoga Ashram

Meditation – the Essentials

Residential and Online Course

September2017 – March 2018

APPLICATION FORM

All information given on this form will be treated as confidential

Please complete all sections as fully as possible. Continue on a separate page if necessary.

Please fill in and submit your application by August 28that the latest. The course is limited to 20 participants and priority will be given to those who apply early on a first come first served basis. Places will be allocated accordingly and your place will be considered only if places on the course are still available.

A. Personal Details (Please PRINT clearly)

Mr/Mrs/Ms/Miss/Swami

Surname: …………………………………..… Forename(s): .………………………………...

Postal Address: ….…………………………………………………………………………......

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Post Code: …….…………………….Telephone: ..………………………………………….

Email: …………………………………………………………………………………………...

Date of Birth…………………………… Male  Female  (Please tick)

Occupation: …………….………………………………………………………………………

B. Medical Information

The course will cover a range of yogic practices and techniques, some of which can be contra indicated or inadvisable for people suffering from certain medical conditions. If you suffer from any of the following, please circle them so that we can bear this in mind when teaching on the course. Please also indicate any condition not stated below.

Abdominal Surgery in the last 3 yearsBack or knee injuriesMigraine

High or Low Blood PressureHeart problems or SurgeryEpilepsy

Pregnancy or postnatal within last 12 monthsHerniasDiabetes

Chest or breathing complaintsArthritisMS

Eating Disorders (current or previous)Addictions (drugs/alcohol)ME

Mental Health Issues – current or previous (anxiety/depression etc.)

Please provide further details on any of the above on a separate sheet if necessary

Any other condition or sensory loss not stated above? .…………………………………………………………………………………………………

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Although the responsibility for your own health and well-being remains your own, the ashram will do all it can to support you with your medical condition whilst on the course; it can do little however if such relevant information is withheld.

Please state what action should be taken should you experience any difficulty whilst in the ashram, arising from any medical or sensory condition outlined above. What are your requirements in such circumstances?

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C. Yoga Experience

1. Have you attended a course in the ashram before? Please tick Yes No  .

If Yes, please give details of date, subject and number of days.

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2. What is your motivation for applying to do this course? (Continue on another sheet if necessary).

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D.Declaration

I am aware that this course is offered in order to give me the training, time, space and support to allow me to go deeper in my understanding and practical experience of the essentials of meditation. This course is oriented toward personal development, growth and meditative experience.

I take full responsibility for my physical and mental health during the course.

Signature: ………………………….…………… Date:………………

Please complete this form and return it to:

Mandala Yoga Ashram

Pantypistyll, Llansadwrn, Llanwrda, Carmarthenshire

Wales, U.K., SA19 8NR

+44 (0)1558) 685358

Mandala Yoga Ashram is an independent charitable institution (Reg. Charity No. 326847) which is dedicated to propagating yoga and yoga-related subjects.