ALL INFORMATION IS CONFIDENTIAL and will be deleted after your stay. PLEASE FILL IN ALL FIELDS AND USE AS MUCH SPACE AS IS NECESSARY. Type N/A if particular question in not applicable.

    Full Name

    Arrival Date

    Departure Date

    Estimated Time of Arrival

    Contact number





    Medical/ Medication

    Please list any relevant medical conditions(diabetes,epilepsy,etc..), or medication that it would be helpful for us to know about.

    General Well-Being

    Have you recently experienced any significant mental health issues such as depression, eating disorders, anxiety or drug/alcohol abuse? Are there recent circumstances (e.g. loss of a loved one, family difficulties, illness, substance abuse, suicidal thoughts) which may affect your stay?
    (If you wish to discuss this in confidence before coming please call Sunyata at 085 135 3695).

    If yes, please give details:

    Emergency Contact number, name and relationship to you

    Previous experience of spiritual practice

    Other retreat centres/monasteries visited

    Why are you interested in visiting Sunyata?

    Are there any particular skills which you could offer during your stay here?