Qi Gong and Meditation

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1 Welcome

2 Booking fee

3 Your information

Phone *
Address line 1 *
Address line 2
City
County
Zip / Postcode *
Country *
Gender *
Non-binary Room Share	If you identify as non-binary we will try to assign you a room share with other non-binary folks. This is not always possible, so we ask that you also let us know which gender room would be best - for you and the other people in the room.
Restricted Diet Information *	Yes No Do you have a restricted diet for medical reasons? We offer a vegan diet at Dhanakosa. To assist our cooks, please limit requirements to essential items only.
Restricted Diet	Gluten free Coeliac Nut allergy Other
Nut allergy	Do you carry an epipen?
Nut allergy	Do you need your own nut-free jam/spread? We can provide new jam/spreads labelled for your sole use.
Nut allergy	Is your allergy so severe that you need all nuts removed from the retreat centre?
Nut allergy - Further details	Please give more details e.g. types of nuts you are allergic to and the level of severity.
Restricted diet - further details	Please give details of dietary restrictions.
Health Information *	Yes No Are there any physical, emotional or mental health issues which could affect your participation in the retreat? Read more information here – Am I well enough to be on retreat?
Health Information - Further Details	All information is confidential and will only be communicated to the retreat team, so they can best support you on the retreat.
Emergency Contact *	Please give a name and phone number of someone we could contact on your behalf in case of an emergency.
Your age *	I confirm I am aged 18 years or over
Limit on number of bookings *	I understand Dhanakosa's limit on the number of retreats I can bookWe ask that you book no more than two week-long retreats a year. This does not include Scottish sangha retreats. This gives as many people as possible the opportunity to come to Dhanakosa.
I agree to share a room *	I agree to share a room Dhanakosa has very limited ability to provide single rooms and you cannot book a single room online. If you have a genuine need for a single room, (e.g. a medical condition, disability or other), please contact the office to book.
Could you use a bunk bed? *	Yes No Some rooms have bunk beds, please let us know whether you would be able to use a bunk bed.
Booking and Cancellation Policy *	I understand Dhanakosa's booking and cancellation policyThe booking fee is only transferable or refundable if you give one month's notice before the start of the retreat. Read our booking and cancellation policy here
Continuity and attendance *	I understand Dhanakosa's policy on continuity and can attend the entire retreatContinuity is an important aspect of being on retreat. It is disruptive to the atmosphere of a retreat to arrive late, leave early or to take excursions. Please tick box to confirm that you understand Dhanakosa’s policy on continuity and can attend the entire retreat.
Would you like to receive the Dhanakosa monthly email newsletter?	Yes
Would you like to receive the annual programme by post?	Yes No

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4 Donate to Dhanakosa

£	Donate for your Retreat The suggested levels of donation for this retreat, in addition to the booking fee, are £690 / £445

5 Payment

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