Page 3 of 6 Insight Meditation Center Retreat Application MEMORIAL DAY FAMILY RETREAT AT JIKOJI May 23 to May 25, 2015 Dietary Needs and Medical Restrictions: Please circle dietary restrictions and print number of attending family members to whom it applies: no dairy:___ no wheat:___ no eggs:___ _________________________ ___ other (please describe): Please describe any special medical needs or mobility limitations and print the name of the family member to whom it applies: Please list each family member’s name who physically able to use an upper are bunk bed: Do any attending family members snore? Please circle YES or NO and, if write their name(s): “yes,” continues Application next page Insight Meditation Center 108 Birch Street Redwood City, CA 94062 Page 4 of 6 Insight Meditation Center Retreat Application MEMORIAL DAY FAMILY RETREAT AT JIKOJI
Page 3 of 6 Insight Meditation Center Retreat Application MEMORIAL DAY FAMILY RETREAT AT JIKOJI May 23 to May 25, 2015 Dietary Needs and Medical Restrictions: Please circle dietary restrictions and print number of attending family members to whom it applies: no dairy:___ no wheat:___ no eggs:___ other (please describe): _________________________ ___ Please describe any special medical needs or mobility limitations and print the name of the family member to whom it applies: Please list each family member’s name who are physically able to use an upper bunk bed: Do any attending family members snore? Please circle YES or NO and, if “yes,” write their name(s): Application continues next page Insight Meditation Center 108 Birch Street Redwood City, CA 94062 Page 4 of 6 Insight Meditation Center Retreat Application MEMORIAL DAY FAMILY RETREAT AT JIKOJI
IMC_5-23-15_Family_Retreat_Application_and_Liability_final.docx