Seva Yoga Program Application - Ananda Meditation Retreat

Date*

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone (Home)*

Phone (Work)

Email*

Gender*

Male
Female

Birth Date*

MM

DD

YYYY

Background Information

The Meditation Retreat, as part of Ananda, is dedicated to following the non-sectarian teachings of Paramhansa Yogananda. While we do not proselytize, this is our spiritual tradition and it is important for Seva Yoga Program guests to be willing to learn and experience what we share here. Our spiritual life is dedicated to God and our particular lineage of yoga masters, including Jesus Christ and Paramhansa Yogananda. Is this comfortable for you?*

Yes
No

How did you hear about us?*

Why would you like to be part of this program?*

What are you preferred dates for participating in this program?*

Daily service includes dish-washing (with heavy pots and pans), housekeeping (cleaning bathrooms, vacuuming, etc.) and gardening. Will you be able to handle this in a responsible and energetic fashion?*

Yes
No

Do you have any special skills such as gardening, carpentry, or cooking?*

Are you willing to commit to attend at least two sadhanas (sessions of yoga and meditation) per day?*

Yes
No

Do you snore?*

Yes
No

Are you willing to commit to not using drugs and/or alcohol either on or off the property while you're in the Seva Yoga Program?*

Yes
No

Have you ever been convicted of a felony?*

Yes (Please explain below)
No

Personal References

Please provide two personal references

Name*

First Last

Phone*

Relationship*

Name*

First Last

Phone*

Relationship*

Personal Health

Do you have any physical limitations or health concerns?*

Yes (please describe the conditions below)
No

Are you currently seeing, or have you seen in the last five years, a physician or therapist for any physical conditions or mental illness?*

Yes (please describe the conditions below)
No

Are you now taking any medications?*

Yes (specify conditions and what medication below)
No

Emergency Contact

Name*

First Last

Relationship*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone (home)*

Phone (work)

You Must Have Medical Insurance Before Arriving for Our Program

Name of carrier*

Expiration date of policy*

Policy number*

Deductible*

Please bring your insurance card with you.

If you have any questions or concerns about your diet, please elaborate in detail.

Important note: Our kitchen offers a varied selection of vegetarian cuisine daily; we can provide dairy-free and wheat-free alternatives upon request, but we are unable to accommodate all special dietary requirements.

Newsletter

Receieve news and upcoming retreats (usually monthly)

Thank you for taking the time to fill out this appication!

Background Information

Personal References

Personal Health

Emergency Contact

You Must Have Medical Insurance Before Arriving for Our Program

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