The Center that Holds Registration

The Center that Holds — Peace Amidst Ferocious Change

Registration Form

Dates: February 28th to March 3rd, 2024

Location: Claymont Society

Claymont Court Estate, Charles Town, WV 25414

Name

First Name

Last Name

Age

This retreat is intended for young people ages 18-35

Phone

(###)

###

####

Have you attended a meditation retreat before?

If so, please list the date, length, teachers, and hosting organization of the 4 most recent. (Note: it's ok if this is your first retreat and this is not applicable)

How did you find out about this retreat?

Have you attended a multi-day Dharma Gates retreat before?

Yes

Please share a brief summary of your experiences with meditation and spiritual practice.

Have you ever been asked to leave a retreat?

Are you working with any mental health concerns right now? If so, have you been formally diagnosed? Have you ever been hospitalized for mental health reasons?

We ask in order to understand more about you and so that we can inform our teacher. We aim to provide a loving, safe container for all retreat participants.

Are you currently taking any psychiatric medications?

Do you have any other concerns or challenges particular to your life or meditation practice that would be helpful for us to know about?

Housing and bathrooms will be shared, with exceptions for those who have medical or mental health needs. Would you prefer to be housed with folks who identify as women? Folks who identify as men? Or in mixed gender housing?

Identify as man

Identify as woman

Mixed gender housing

What is your gender identity? Do you have personal pronouns?

(optional)

What race or ethnicity do you identify with?

(optional)

Are you from a low-income/low net-wealth family background?

(optional)

Will you commit to attending the entire duration of this retreat?

Do you have any allergies or dietary constraints?

The food offered on the retreat will be Vegan

Emergency Contact

Please provide the name and phone number of an emergency contact 💌

Carpooling & Rideshare

Dharma Gates supports participants to offer and ask for rides. Accessibility is really important to us - we want to help those without vehicles to attend this event more easily. In order to facilitate this, we are grateful to those who have cars and volunteer to drive other participants. Please indicate below whether you need a ride or can offer a ride. If you are offering a ride, please mention where you are driving from. For this retreat, rides will be especially offered from Washington, DC, so if you are from out of state and can get to Washington, DC (by plane or train), that is great. Thank you :) Note: from a liability perspective, we are unable to formally guarantee you a ride as an organization. That said, it almost always works out that everyone who needs a ride is able to find one.

If you are presenting with COVID-19 symptoms or any other serious illness, please do not attend the retreat. Depending on COVID rates, we may ask participants to take a rapid test in the week leading up to the retreat.

I confirm that I understand the Dharma Gates health policy.

Retreat Deposit

This retreat is offered on a donation-basis in the spirit of Dana. In order to ensure your attendance the retreat, and due to limited amount of space, we ask you to make a $100 deposit to secure your place. You can make this deposit via Venmo (@dharma-gates) or Paypal (team@dharma-gates.org). You will receive this deposit back upon your attendance of the retreat, or if you cancel with more than 3 weeks of notice of the retreat. This is not a retreat fee. There are no required fees for attending this retreat and all the food, housing and teachings are offered to you on a donation-basis. If a deposit of $100 is not accessible for you right now, please email team@dharma-gates.org.

I confirm I have made a deposit to Dharma Gates

Please select if you would like to donate your deposit or have it refunded after the retreat