Retreat Registration

First Name*

Last Name*

Gender pronouns

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Is this your first silent, multi day meditation retreat?*

Yes
No

Is this your first time retreating with us at Bethany Hills?*

Yes
No

Age*

I will be attending:*

Three nights
Five Nights

Room Preference

Shared Room
Single Room

We can't guarantee single rooms but will make note of your preference. If you have a condition that makes sharing a room difficult for others, such as snoring or using a CPAP machine, please let us know in the box below.

Specific information on rooming needs.

Seating Preference

Chair
Floor/cushions
Chair and Floor/cushions

Special Needs

Chemical/Fragrance Sensitivities
Ambulatory Difficulties
Hard of Hearing

Dietary Needs

Meals will primarily be vegan with some dairy options. Please include any allergies or other pertinent information in the additional notes box below

Vegan
Gluten Free

Are you able to support our mission of making retreats accessible to all with a donation to our scholarship fund? If so, write amount below and add to your retreat fee. Thank you!

Once your registration and payment are received, you will hear from our registrar with a confirmation. He will update you on when you can expect several informational emails. Please add additional notes here:

Consent*

I have read and agree to the liability waiver.

I do hereby, in consideration for the participation at a meditation retreat hosted by One Dharma Nashville (hereinafter referred to as the “Releasee”) do hereby release the Releasee including its agents, employees, successors and assigns, and their respective heirs, personal representatives, affiliates, successors and assigns, and any and all persons, firms or corporations liable or who might be claimed to be liable, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, which I now have or may hereafter have, arising out of or in any way relating to any and all injuries, illnesses, and damages of any and every kind, to both person and property, and also any and all injuries, illnesses, and damages that may develop in the future, as a result of or in any way relating to my arrival, my participation in, and departure from a meditation retreat at Bethany Hills Retreat Center.

It is understood and agreed that this Release is made and received in full and complete settlement and satisfaction the causes of action, claims, and demands mentioned herein. This Release contains the entire agreement between the parties. The terms of this Release are contractual and not merely a recital. Furthermore, this Release shall be binding upon the undersigned, and their respective heirs, executors, administrators, personal representatives, successors, and assigns. This Release shall be subject to and governed by the laws of the state of Tennessee.

This Release has been read and fully understood by the registrant.

Emergency Contact Name*

Emergency Contact Phone Number*

To help us with record keeping please let us know the method of payment you will use.*

Venmo or Paypal
Check