Phone Gaia House on +44 (0) 1626 333 613 Email Gaia House info@gaiahouse.co.uk Gaia House on Facebook @GaiaHouseUK on Twitter Group Retreat Programme Go to Checkout return to home page

Retreat Application Form – Of Hermits and Lovers: The Alchemy of Desire

Retreat Application Form - Of Hermits and Lovers: The Alchemy of Desire

This retreat will be suitable for people who have the pre-requisite meditation experience, who particularly wish to explore this theme, and who are well resourced psychologically. We will try to respond to your application within 14 days of our receiving it.

Name and Contact Details

First Name *
Last Name *
Address *
Town / City *
County / State
Post Code
Country *
Email*
Phone*
Additional Phone

Booking Details

Retreat Dates: Sunday 26 March 2017 – Sunday 2 April 2017 (7 nights)

You are expected to commit to arrive for the start of the retreat and to stay until the end of the closing session.

Retreat Costs:
  • Standard Rate: £385 - Please be willing to pay this rate if you can
  • Supported Rate: £327 - Available if you cannot afford the Standard Rate
  • Sponsor Rate: £462 - A benefactor rate, which helps others to come here on the Supported Rate
Extend your Retreat = £43 per night
  • You can arrive one day early and/or stay on for an extra day
  • Retreat Conditions apply:
  • Observe silence.
  • Follow the daily schedule.
  • Practise meditation.
  • (To extend your retreat for longer, please apply as a Personal
    Retreatant)
I would like to pay the: Standard Rate = £385Supported Rate = £327Sponsor Rate = £462
I would also like to stay: One night before the retreat beginsOne night after the retreat ends

Booking and Cancellation Conditions

Payment and Deposits:

  • Retreats up to and including 3 nights: Please pay in full at the time of booking.
  • Retreats of 4 nights or more: A non-refundable, non-transferable deposit of £100 will secure your place. Please pay the balance at least one month before the start date.
  • If you have paid a deposit, an email will be sent to you to remind you to pay the outstanding balance.
  • If you have not paid in full, one month before the start of your retreat, your place may be cancelled (with the loss of your deposit), and offered to someone on the waiting list.

Cancellation and Refunds:

  • If you cancel more than 1 month before the start date of the retreat, the cancellation fee will be £100.
    • Please note that the Sponsor rate includes a non-refundable donation and is refunded at the Standard rate.
    • For low cost retreats such as Day Retreats, Dana Retreat, Work Retreat or Young Persons Retreat, the cancellation fee will be £10.
  • If you cancel less than 1 month but more than 2 weeks before the start date, the cancellation fee will be £100 or half the cost of your retreat, whichever is greater.
  • Extra nights cancelled more than 1 month before your arrival date will be refunded, less a £20 admin fee.
  • Extra nights cancelled less than 1 month in advance will be charged in full.
  • If you cancel less than 2 weeks before the start date, the cancellation fee will be the full amount paid.

Cancellation fees (less administration costs) are placed in the Financial Assistance and Bursaries Fund (FAB Fund).

Booking conditions may be subject to alteration.
See: Booking and Cancellation.

I have read and agree to the Booking & Cancellation Conditions *

Personal Details

This helps us to arrange appropriate accommodation.
Gender * FemaleMaleAnother gender identity
Additional information (optional)

You are welcome to provide additional information if you would like to. Our Retreat Manager will contact you via email to discuss your accommodation needs. Any information you provide is confidential and will only be used in support of your retreat.

Do you have specific needs relating to a disability or health condition? NoYes
Additional information (optional)

You are welcome to provide additional information if you would like to. Our Retreat Manager will contact you via email to discuss your needs. Any information you provide is confidential and will only be used in support of your retreat.

Date of Birth *
Have you attended a retreat at Gaia House in the last 5 years? * NoYes

FOOD POLICY

Gaia House offers a healthy, balanced vegetarian diet that may include eggs and dairy produce.

  • Vegan, dairy-free and wheat/gluten-free options can be requested when you register on arrival.
  • We also offer a ‘Simple Diet’ consisting of a gluten-free wholegrain, steamed vegetables and plain pulses, egg or tofu. This diet is intended to meet nutritional needs whilst being as plain as possible. You can request the simple diet when you register on arrival.

If none of the above options meet your dietary needs, or you have a medical need for a different diet, please contact our Retreat Manager, Susanne O’Brien, on retreatmanager@nullgaiahouse.co.uk before booking your retreat.

Food Allergy/Sensitivity:

  • We always label dishes containing any allergens you have told us about.
  • Whilst on retreat, please speak to a member of the Gaia House team for more information on allergens in our dishes.

I have read the Food Policy and am aware of the dietary options. *

Keep in touch with Gaia House:

Gaia House E-News - sent occasionally by email.
Retreat Programme and Newsletter - sent once a year by post, to recent retreatants Yes PleaseNo Thanks
Your details will not be shared with anyone.

Practice Information

The following information is strictly for the confidential use of teachers and staff on a need to know basis. Please answer these questions fully to enable the teachers to guide your retreat appropriately. Disclosure of any physical/psychological history will not necessarily prevent you from undertaking a retreat.

Please state "no" or "none" to any questions that don't apply.

Please list the four weeks of Insight meditation retreats you have undertaken, and any other relevant retreats you have participated in, their duration, approximate dates, and the teacher(s) with whom you have practised.*
Please tell us a little about your relationship with the themes of this retreat, and your intentions for doing it.*
Please outline and describe briefly your experience with each of the following:*

  1. Imaginal practice:
  2. Emptiness practices:
  3. Metta:
  4. Insight meditation:
  5. Samatha:
  6. Working with the energy/emotional body:

Physical & Psychological History

Please note: A difficult psychological history and present will not necessarily prevent you from being accepted for this retreat. However, we do need to feel confident that you have the capacity and resources to be self-supporting in the silent retreat environment.
Please give details of any psychological difficulties (past and present) and let us know what inner and outer supports you currently have for working with these, including if you are supported by mental health services.*
Is there any additional information you would like to convey to the teacher(s). *

Emergency Contact Details

Please give details of someone we can contact in the event of an emergency.

Emergency Contact Name*
Emergency Contact Phone Number*
Other Emergency Contact Information
We very much look forward to welcoming you to Gaia House. It is important to us to be truly inclusive and welcome all people. We invite you to contact our Reception team if you want to tell us more about how we can welcome you: Email info@nullgaiahouse.co.uk or call 01626 333613.
I will be able to arrive for the start of the retreat and to stay until the end of the closing session. I agree to take full responsibility for myself during this course.
Retreatant Signature*
(please type in your full name in lieu of a signature)

* = required