Nan Tien Temple

Free Sunday Meditation and Cultivation Class

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Applicant Details

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Class Details:

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Have you participated in any courses/retreats at Nan Tien Temple before?  *
Yes   Please specify   *
No     Have you read any books in Buddhist Studies?

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Additional Information

Please answer the following questions.
Please give details if you answer "Yes" to the following questions; (type, frequency, amount etc.)
All information will be kept strictly confidential. Thank you for your co-operation.

1. Do you have or ever had any physical health problems; e.g. Diabetes, heart disease, epilepsy etc.? Yes No

2. Do you have or ever had any mental health problems; e.g. significant depression, anxiety, panic attacks, schizophrenia etc.? Yes No

3. Are you now taking, or have you taken any drugs in the past two years; e.g. Barbiturates, cocaine, amphetamines, alcohol, marijuana or other intoxicants? Yes No

Media Policy Agreement

Fo Guang Shan Nan Tien Temple reserves the right to take photographs, images, video, or audio recordings of the classes and activities during the event for temple records, website and future publications.

By choosing 'Yes' it indicates that you have fully read, understand, and agree to the terms of the above "Media Policy Agreement" in its entirety and also give your consent to use your image in temple publications.

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Declaration

I hereby declare that:

The information I have provided in this application is true and correct, and I will notify Nan Tien Temple of any change.
I have read all the information related to this retreat/course, and accept and agree to all of its Terms and Conditions. I agree to abide by Nan Tien Temple's policies and procedures for the duration of the retreat/course.
I take full responsibility and liability for my own health and safety, including any accidents, risks, or "acts of nature" during the retreat/course.
I have read and agree to the Refund Policy and the Privacy Policy.

Confirmation

* I acknowledge that it is a condition of my application that I have read, understood, acknowledged and agreed to the above declaration.

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