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Personal Retreat Application Form

Please Note: Before booking a Personal Retreat, you need to have completed at least 2 weeks teacher-led, Insight (Vipassana) or Zen meditation retreat in silence (either as two separate weeks or one continuous retreat of 14 days), not necessarily at Gaia House. 

All Personal Retreat Application forms will be submitted to a Gaia House teacher for approval. Applications from people who do not have sufficient previous experience will be refused. If you have any questions before you apply, please call Reception: +44 (0)1626 333613

You can use the Personal Retreat Cost Calculator to calculate the cost of your proposed retreat.

Name and Contact Details

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

Booking Details

Requested Retreat Dates - Make sure you enter the correct dates...
From * (the day you arrive)
To * (the day you leave)
Booking and Cancellation Conditions

Payment and Deposits:

  • For retreats up to and including 3 nights, full payment is required at the time of booking.
  • For longer retreats, a non-refundable, non-transferrable deposit of £100 will secure your place, but the balance must be paid at least one month prior to the start date.
  • If you have paid a deposit, an email will be sent to you, to remind you to pay the outstanding balance.
  • Please Note: 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 1 month (or more) before the retreat start date, you will lose your deposit
  • Cancellation of a retreat less than one month, but more than 2 weeks prior to the start date will incur half the cost of your retreat, or your deposit - whichever is greater.
  • Cancellation of a retreat less than 2 weeks before the start of the retreat, will incur the loss of the full amount paid.

After administration costs have been paid, remaining cancellation fees are placed in the Financial Assistance and Bursaries Fund.

Booking conditions may be subject to alteration.

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

Personal Details

Gender *  Female Male
Date of Birth *
Have you attended a retreat at Gaia House in the last 5 years? *  No Yes


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 ku.oc.esuohaiagnull@reganamtaerter before booking your retreat.

Food Allergy/Sensitivity:

  • We always label dishes containing any allergens you have told us about.
  • Whilst on retreat, information on any allergens within our dishes is available by speaking to a member of the Gaia House team..

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

Mailing List for Retreat Programmes and Newsletters

Please add me to the Mailing List:

(Your details will not be shared with anyone.)

 Yes Please No Thanks

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.

Personal Retreats at Gaia House include a daily one-hour work period. Retreatants are allocated to a department according to the needs of the house. If you have any limitations, which may affect your ability to carry out a work period, please give details:*
Please provide information about any special needs you may have that we need to be aware of, for example, allergies or medical conditions: *
Gaia House is a silent retreat environment for sustained meditation practice. Retreatants need to be experienced and committed to both silence and solitude. Please list all silent meditation retreats you have undertaken, their duration and the teachers with whom you have practised. (If the list is extensive, please state this with a summary and list only your most recent retreats.): *
What are your intentions regarding your meditation practice during your time on retreat? Which particular styles of meditation do you intend focusing on? *
Personal Retreatants staying longer than 1 week: Interviews will be offered twice a week with one of the Gaia House Teachers, is this sufficient support for you? *
If your retreat is for longer than a month please send a reference (if possible) from a meditation teacher with whom you have previously practised or provide his/her contact details. *

Physical & Psychological History

Do you have any history of physical illness or any disabilities, which may significantly affect your sitting, standing or walking practice? *
Have you ever been diagnosed with or experienced any significant mental health issues e.g. depression, eating disorders, anxiety, drug/alcohol abuse? If yes, please give details of condition(s) and date(s). *
Are you taking any medication for any physical or psychological condition? If yes, please give details of condition and medication. *
Have you ever attempted to take your own life? If yes, please indicate date(s) *
If you are involved with mental health services and have a Community Psychiatric Nurse, Psychiatrist or Support worker please provide their name and telephone number. *
Describe any present circumstances which might be placing you under additional stress or may significantly affect your meditation practice (e.g. bereavement, redundancy, relationship breakdown etc) *

Emergency Contact Details

Name & Telephone Number(s) of someone we can contact in case of emergency: *
I agree to take full responsibility for myself during this retreat. I understand that all retreatants need to observe the practice guidelines and that retreats at Gaia House are undertaken and continued with the agreement of the teacher.
Retreatant Signature (please type in your full name in lieu of a signature)

* = required