Application Form

Retreat: Mindfulness and Self-Compassion MOVED ONLINE NOW COURSE 816

Terms & Conditions
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I confirm by ticking this box that I have read the course description and relevant information sheets and understand and agree to the Terms & Conditions of the Mindfulness Network.

About you










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I am a Mindfulness Network Associate:
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Your Mindfulness experience and practice



Course fees


Recognising the administrative overhead of dealing with employers, we will be adding a £50 surcharge if the employer is paying directly; where possible we would recommend that applicants pay themselves and reclaim on expenses to avoid the charge. Responsibility for payment remains with the attendee. Please note: If your employer is paying, a deposit option will not be available, and the full amount will be invoiced.

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Your physical and mental health
It is helpful for us to have some information about you so that we can best meet your needs at the event. Please provide information, if possible, to the following questions:


Please provide further information:
It is important to us to be able to fully welcome everyone. If you have any specific needs relating to disability or health conditions, including difficulties with hearing, please contact us before the event so that we can discuss ways that we can support you during the event.
Please read these guidelines before completing the following question:
Silent meditation retreats can be very supportive to wellbeing; however, due to their intensive nature, it is advised that they are undertaken at a time of relative stability in psychological health. If you have recently (within the past year) experienced significant trauma or psychiatric illness, or if you are currently experiencing acute emotional distress such as serious depression or anxiety, this may not be the best time for you to attend a silent retreat and contexts offering more interpersonal support are likely to be more helpful.

If you are currently under the care of a mental health professional, please discuss your attendance with them. You should be in a relatively stable period of mental well-being and have adequate psychological resilience to attend an intensive silent retreat.

Please answer the following question with these guidelines in mind. If there is any uncertainty about whether this is a good time for you to attend this retreat, we can organise a time for you to discuss this with our retreat lead. If you would like to organise a time to speak, please contact us on: retreats@mindfulness-network.org

Please provide further information:

Once your application form has been received we will be in contact with you to complete your booking for this event.

Your booking information

If you prefer to use your own term, please specify here:

Do you require a vegan diet?
Do you have any specific dietary requirements, related to a medical condition or a food allergy, that we need to be aware of?
Trigonos provides nourishing and freshly prepared vegetarian food made from healthy and good quality ingredients. For more about how they cater for guests please see: http://www.trigonos.org/bringing-a-group/sample-page/

If you have specific dietary requirements please complete this section.

Trigons cannot cater for you if we do not know what you need.

  • If you have a food allergy please complete the allergy chart.
    A food allergy is when the body's immune system reacts unusually to specific foods. Although allergic reactions are often mild, they can be very serious and even life threatening. Only a tiny particle of food is needed to trigger a food allergy. Sufferers usually have a medical confirmation of their condition.

  • If you have any other essential dietary requirement please list it below. An essential dietary need can include restrictions due to:

    Food intolerances that produce symptoms, such as digestive discomfort etc that can develop up to several hours after eating. The symptoms of a food intolerance are never immediately life threatening.

    Religious Beliefs etc.
    Trigonos are not able to cater for individual preferences or tastes, only for essential dietary requirements.

    Please help us by being concise in any description you give:

    Trigonos plan their menus and order ingredients in advance of our arrival. They then cannot accommodate late requests for changes in what they provide. Please be sure you have fully completed this form so that your requirements can be met.

    Notification of food allergies
    A food allergy is when the body's immune system reacts unusually to specific foods. Although allergic reactions are often mild, they can be very serious and even life threatening. Only a tiny particle of food is needed to trigger a food allergy. Sufferers usually have a medical confirmation of their condition.

    To help us provide food and drink that is safe for you to eat please clearly tick the appropriate box for any item to which you have an allergy:

    CeleryCrustaceansEggsGlutenLupinMilkFish
    MolluscsMustardPeanutsSesame seedsSoybeansSulphur dioxide/Sulphites
    NB: List all the key allergens even though some are rarely, if ever, used in the kitchen

    If you have an allergy to tree nuts, please clearly tick the appropriate box (s):

    AlmondsBrazilsCashewsHazelnuts
    Macademias (aka Queensland nutsPecansPistachiosWalnuts

    If you have another food allergy (using the definition above) please clearly list them here:

    IMPORTANT: We take great care in ensuring that allergens are not used as an ingredient where their exclusion is required. However we cannot guarantee that our food does not contain trace elements of allergens as we do not have a separate kitchen for preparing allergen free dishes.

  • Other information