Women’s Regional Order Weekend

* These fields are required

1 Welcome

2 People in your group

3 Participant Info

* Denotes a required field you must complete.

Mobile Phone / Phone *	Please provide a mobile phone number if possible
If we need to contact you regarding your booking, How can we contact you? *	Email (we will usually use email) Phone Call Whats App Text Please select which methods you consent to us using - EMAIL is our main method
Gender *
Your age *	I confirm I am aged 18 years or over
What will your age be at time of retreat	Optional...but may be helpful for us to know
Address line 1 *
Address line 2	Optional Secondary line of address
Town / City *
County *	e.g East Sussex, Kent etc
Postcode / ZIP *
Country *
Do you have any Dietary restrictions *	No Yes Rivendell provides a well balanced vegan diet. Sorry we are unable to provide non vegan food here. If you have diet restrictions for genuine medical reasons please select 'Yes' and you can add further details. If you have further questions please contact Rivendell.
Special diet information	Please provide details about your restricted diet. To help our volunteer cooks, please keep special food requests to absolutely essential requirements only. Thank you.
Are there any emotional or mental health issues which could affect your participation in the retreat? *	No Yes Read more information here - Are you well enough to be on retreat?
Your current health condition *	Please fill out any details you think we need to know about your current health condition. Any information given will not be given to other retreatants and is treated in strictest confidence and only shared with Retreat leaders/team members that would need to know for legal/health reasons.
Are you physically able to help out? *	Yes No Retreats at Rivendell include helping out with light domestic tasks; washing up, laying out for meals, etc and a clear up at the end of the retreat. Are there any limitations which may affect your ability to help out with basic domestic tasks?
Limitations on assisting on domestic tasks *
Have you attended a retreat at Rivendell in the last 5 years? *	Yes No
Triratna Buddhist Community Experience *	I have no previous experience of Triratna Buddhist Community I attend a Triratna centre / activities occasionally I attend a Triratna centre activities regularly I am a Mitra I am an Order Member
Triratna Order Name	If you are ordained in the Triratna Buddhist order please add your name here
Emergency Contact Name *	In case of emergency please provide details of someone we can contact on your behalf:
Emergency Contact Relationship *	Please let us know the persons relationship to you: e.g Friend, Partner, Family member
Emergency Contact Phone *	Please add the telephone number of your Emergency Contact

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4 Accommodation

I agree to share a room	Please tick this box to confirm you understand that you will be sharing a single sex room
Single room	Due to the layout of the building we are usually only able to offer 1 single room which is allocated to those with disability or a medical health condition. Special accommodation requests cannot be guaranteed, however we will do our best to accommodate according to needs. Contact us if you need to discuss your needs in more detail.
Request for a single room	If you need to request a single room, please give us the reason for your request, thank you.

5 Communications and policies

Email newsletter	Please send me the monthly email newsletter

6 Donate to our bursary fund

£

7 Security Check

Security check

Guest 1		First Name / + Order name if ordained* Last Name* Email*
Guest 1		First Name / + Order name if ordained* Last Name* Email*