The Family Retreat (242R25)

PLEASE READ: This form should be completed with the Primary Contact person's information in all the registration fields, except in the "People in your group" section where you will list names of all attendees (this section will appear once you select 2 or more people in your group. You may enter payment details with an alternate parent/caregiver's information in the Payment section.

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1 Welcome

2 Price

Please consider paying at the highest rate that you can afford: your generosity supports Spirit Rock's efforts in offering lower sliding scale rates and supporting the large number of scholarship requests.

Any amount paid above the Sustainer Rate is a tax deductible donation to Spirit Rock and helps to support those families that need to pay less. Registration fees DO NOT include teacher dana. At the end of the retreat, there will be an opportunity to offer dana to the teachers and to Spirit Rock. Your confirmation email is your tax receipt.

Select a sliding scale rate for EACH person attending and be sure it is the rate you were approved for. All scholarship rates have been allocated; please DO NOT select a "reduced" or scholarship rate unless you have been pre-approved.

Select an option*

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Benefactor-residential.

Contributing at the Benefactor rate: “The gift of Dharma surpasses all gifts.” – The Buddha; Covers the cost of the...

Number of Guests:
In rooms

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$1,760

$1,760

$1,760
Benefactor-residential.

Contributing at the Benefactor rate:
“The gift of Dharma surpasses all gifts.” – The Buddha;

Covers the cost of the retreat with a meaningful contribution;

Upholds Spirit Rock programs, nurturing their growth and impact;

High probability of a single room accommodation;

Your gift is tax deductible (amount above Sustainer rate).
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Sustainer-residential.

Contributing at the Sustainer rate: “Generosity is the beginning of awakening.” – The Buddha; Covers the cost of the retreat;...

Number of Guests:
In rooms

More Details +

$1,320

$1,320

$1,320
Sustainer-residential.

Contributing at the Sustainer rate:
“Generosity is the beginning of awakening.” – The Buddha;

Covers the cost of the retreat; not tax-deductible;

Room assignment may be shared (2-person) or single, depending upon availability.
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Basic Rate-residential.

Contributing at the Basic rate: Covers a portion of the retreat costs; Partially subsidized and not tax deductible; Room assignment...

Number of Guests:
In rooms

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$880

$880

$880
Basic Rate-residential.

Contributing at the Basic rate:

Covers a portion of the retreat costs;

Partially subsidized and not tax deductible;

Room assignment may be shared (2-person) or single, depending upon availability.
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Mudita/Karuna Scholarship Rate-residential.

Contributing at the Scholarship rate – Muditā/Karuṇa Scholarship: Deeply subsidized rate; does not cover program costs; not tax-deductible; Room assignment...

Number of Guests:
In rooms

More Details +

$380

$380

$380
Mudita/Karuna Scholarship Rate-residential.

Contributing at the Scholarship rate – Muditā/Karuṇa Scholarship:

Deeply subsidized rate; does not cover program costs; not tax-deductible;

Room assignment may be shared (2-person) or single, depending upon availability.

Muditā: supports any individual who has significant financial need; this includes our low income folks and elders (65+) on fixed incomes;

Karuṇa: supports individuals who have significant financial need and have a serious medical condition, or life-threatening illness.
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BIPOC Scholarship Rate-residential.

Contributing at the Scholarship rate – Dr. Marlene Jones People of Color Scholarship: Deeply subsidized rate; does not cover program...

Number of Guests:
In rooms

More Details +

$380

$380

$380
BIPOC Scholarship Rate-residential.

Contributing at the Scholarship rate – Dr. Marlene Jones People of Color Scholarship:

Deeply subsidized rate; does not cover program costs; not tax-deductible;

Room assignment may be shared (2-person) or single, depending upon availability.

Supports individuals who have significant financial need and who self-identify as Black, Indigenous, and/or a Person of color.
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Cancellation Policy*: (per person)

Standard Cancellation Fees:

$50: On or before 12 weeks
$100: 8-12 weeks before
$175: 4-8 weeks before
$300: 2-4 weeks before
No refunds as of 2 weeks before

Scholarship Rate Cancellation Fees:

Full refund: On or before 12 weeks
$75: 8-12 weeks before
$100: 4-8 weeks before
$200: 2-4 weeks before
No refunds as of 2 weeks before

*Fees reduced for serious illness or death in family

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3 People in your group

Please complete first & last name and gender fields of all attendees. Fill in the email for the Guest 1 (Primary Contact) only. We only need one (1) email, so you may leave all other guest email fields empty. ~Thank you!

Guest 1		First Name* Last Name* Email* Gender*
Guest 1		First Name* Last Name* Email* Gender*

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5 Practitioner Details

What are your pronouns? *
City *
State/Province *	This list includes US and Canada, States/Provinces. For all other countries, please select "Other" at the end of this list and then select your country below.
Zip/postal code *
Country *
Birth date *	We ask this for validating your account; and for emergency purposes and rooming for in-person programs. We do not share this information outside of our organization.
Meditation Practice Experience-ResRetreats *	New to Vipassana residential retreat practice. I've attended 1-3 residential retreats. I've attended 4-10 residential retreats. I've attended 10+ residential retreats.
Emergency contact name *	Please include the name of someone who will be available during your retreat/program. For Residential retreats, if you are traveling from a foreign country, we would prefer that you provide a contact person who is in the United States.
Emergency contact relationship *
Emergency contact phone *	Please include the best number to reach your emergency contact person while you are on retreat or participating in our program. This will not be used for anything except to care for you in case of an unexpected crisis or emergency.
Liability Waiver for Participating in On-Land Programs - By checking this box *	I AGREE - I acknowledge that I have read and agree to the terms in this "Liability Waiver"PLEASE READ - LIABILITY WAIVER
Gender *
How do you self-identify your gender?
Do you self-identify as BIPOC? *	Yes-BIPOC No-BIPOC Decline to state-BIPOC Spirit Rock holds the intention to increase participation of Black, Indigenous, and People of color (BIPOC) in our programs. To support this commitment, we prioritize a portion of all retreat spaces for BIPOC community.
Describe your ethnic origin or race *
Do you self-identify as LGBTQIA+? *	Yes-LGBTQIA+ No-LGBTQIA+ Decline to state-LGBTQIA+
How would you describe your sexual orientation?	Optional.

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6 Accommodations and Food

We have more single rooms than double rooms; however, due the high number of single-room requests, we cannot honor all requests. All attendees should be prepared for the possibility they will be in a shared accommodation and to "accept what is offered" in the spirit of the precepts. Room priority is reserved for those with serious medical needs with a limited number also reserved for those selecting the Supporter rate which guarantees a single room. All remaining rooms will be randomly assigned. We gratefully welcome room-share requests.

First-floor room needed?	Yes, I have mobility limitations.Only select if you MUST be on a first-floor room. We prioritize first-floor rooms for those with mobility limitations and elders in need.
Describe any serious mobility/physical limits we should be aware of	This includes: if you use a personal wheelchair and/or if you have an ADA certified service dog; if you are DEAF, or have severe Blindness. We would like to connect with you as soon as possible to see how we can support your participation.
Need scooter	Yes, I need to reserve a scooter.We have a maximum of four scooters available per retreat. If you have a serious mobility issue, we recommend that you reserve a scooter.
Chemical sensitivity	Yes, I need to be in a chemically sensitive building.We have one dormitory that has wood flooring and no carpeting throughout the building. If you have allergies or are a chemically sensitive being, we recommend this building for you.
Allergies *	No food allergies Yes food allergies FOOD ALLERGIES Spirit Rock serves lacto-ovo-vegetarian meals. We cook with seasonal, organic products whenever possible and source from local farmers and other suppliers for the freshest ingredients available. We have a 'simple foods' table available for those with particular food limitations and every food dish is labeled with the ingredients used so you may use your own discretion. You’ll have an opportunity to let the cooks know about your particular food needs. If 'YES', PLEASE TELL US WHAT THE FOOD ALLERGY IS AND THE LEVEL OF SEVERITY.
What is your food allergy and level of severity?*	*We are NOT able to accommodate extreme dietary preferences. However, if you have a LIFE-THREATENING ALLERGY (eg. peanut) we should have a conversation with you before you attend a retreat here. Please contact the Registration Department as soon as possible.
Dietary Retrictions	Vegan Gluten Free Check all that apply.

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7 Tell Us More

New to Spirit Rock? *	Yes-new to Spirit Rock No-not new to Spirit Rock
How did you hear about Spirit Rock?
May we share your contact information with the teacher(s) or presenter? *	Yes No
Image Consent	I AGREE - I acknowledge that I have read and agree to the terms in this "Image Consent"PLEASE READ - IMAGE CONSENT: I grant permission to Spirit Rock Meditation Center to take photographs and/or record digital media of me for use in promotional materials. These materials might include printed or digital products. I authorize the use of these images and recordings without compensation to me. All images and recordings shall be the property of Spirit Rock.

8 Payment

Credit Card Fee (non-refundable)	Credit Card Fee Opt-in I agree to cover the credit card processing fees for my registration. I understand that this fee is non-refundable if I should cancel my registration.
3% Credit Card Fee (non-refundable)	$0

Sub Total	$0

Taxes	$0

30% Deposit	$0
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1 Welcome

2 Price

Select an option*

Benefactor-residential.

Sustainer-residential.

Basic Rate-residential.

Mudita/Karuna Scholarship Rate-residential.

BIPOC Scholarship Rate-residential.

3 People in your group

4 Additional Programs

Participants

5 Practitioner Details

6 Accommodations and Food

7 Tell Us More

8 Payment