staying @ dhammasara : lay guest Home / our locations / staying @ dhammasara / staying @ dhammasara : lay guest Returning Lay Guest Form – click here Lay Guest Application All guests must have Health Insurance coverage (Medicare included). Your proposed stay dates (Nov 2019 to Dec 2020 Bookings only, excluding Rains Retreat: 4 Jul - 2 Oct 2020)*Guests from Western Australia are usually offered up to 2 weeks stay at a time. Interstate/overseas guests may apply for up to 4 weeks.Salutation*Ms/MissMrs.Dr.Given Names*Surname*Email Address* Phone NumberStreet Address*Street Line 2City*State/Province/Region*ZIP/Postal CodeCountry*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweDate of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Family Status*Select oneNever MarriedMarriedIn stable relationshipDivorced/SeperatedWidowedYour Nationality*AustralianDo you drive regularly and have a valid driver's licence?*YesNoAre you a member of BSWA or affiliates?*YesNoDo you consider yourself to be a Buddhist?*If you do, which tradition & teacher (if any) are you affiliated with?Have you completed any meditation retreats?*Please provide approximate regularity and lengths of retreat(s)Why do you want to stay at Dhammasara Monastery?*Have you visited Dhammasara Monastery before?*YesNoHave you stayed in monasteries or retreat centres?*Please provide details of your stay (including at Dhammasara) Your education background, work experience and other skills/talents?*Do you have any physical health problems?*Guest are expected to participate in daily monastery work. Give details of any conditions that may endanger you during your stay.Do you have any mental health problems?*Please specify any mental health issues, including medication/treatment and when did you last suffer from it.Are you taking any medications?*Please bring along your medications during your stay. Do you have any special dietary requirements?*We depend on alms of vegetarian and non-vegetarian food. Please bring your own supplements if you are on special diet.No special dietVegetarianWhom should we contact in an emergency?*Your Relationship with this person, their Name and Contact number.Your health insurance provider and expiry date.*All guests must have health coverage (Medicare included) during their stay.Photo Identification*A recent photo for us to know you. For overseas visitors, please upload your passport bio page.Other Supporting Documents (.jpg, .gif, .png, .pdf) Drop files here or Declaration*Check all boxes to indicate your agreement to the conditions of stay. Your stay dates cannot be extended without prior approval from the Monastery. I have read and understand the information page for visitors. I have Medical Insurance coverage and in the event that i am hospitalised or needing medical treatment, I will organise for this funding myself. Dhammasara and BSWA will not be responsible for my personal expenses including medical and transportation. I have a Valid Australian Visa during my stay, and will not overstay the duration granted. Your Signature / Initials*By placing your initials here, we interpret this as being your legally valid signature.Date Signed / Initialled*CommentsThis field is for validation purposes and should be left unchanged.