Application

ASCII TEXT APPLICATION FORM FOR MEDITATION COURSE

AT DHAMMA KHETTA, HYDERABAD.

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APPLICATION FORM

I would like to participate in the Children's Anapana Meditation Course from dt:______ to dt:______ at _________.

I undertake to observe five precepts, namely, practicing abstention from killing, stealing, lying, sexual misconduct and use of intoxicants. I undertake to abide by the course Timetable and discipline.
I also agree to stay for the entire duration of the course.

Signature:
Date:

FULL NAME :
GIRL/BOY:
AGE:

FULL ADDRESS :

PINCODE:
PHONE NOS :
E-MAIL :
EDUCATION :
SCHOOL :
MOTHER TONGUE:

ANY PHYSICAL AILMENTS:

ANY MENTAL AILMENTS:

ANY MEDICATION :

ANY OTHER TYPE OF MEDITATION PRACTICED BEFORE:

IF YOU ARE AN OLD STUDENT (Have you attended any Anapana courses in the past?) :

FIRST COURSE
LAST COURSE
TOTAL NO OF COURSES

ARE YOU PRACTICING DAILY;