2023 UK Annual Teen Retreat Registration Form - Inward Bound Mindfulness Education (UK)

8th-13th August – Kench hill, Kent

To register for the 2023 UK summer retreat please fill out the confidential online registration form below.
If you have any issues completing the form online, or if you would prefer to talk to us about any of these questions rather than fill in the form, please contact kareem@ibme.org.uk
Please allow 30 minutes to complete the form.

The information provided on this form is confidential and is used solely for registration purposes for this retreat.

At the end of the application you will be asked for your initial and name. This is your signature to your application. If the applicant is under 18, the electronic signature MUST be completed by the parent or guardian.

Participant First Name*

Participant Surname*

Participant Email*

Participant Phone*

Outside UK?

Participant Street Address*

Participant City*

Participant County*

Participant Post Code*

Participant Country*

Participant Gender*

Participant Date of Birth*

Parent/guardian contact must be different than that of young person. If applicant is over 18, a parent contact or alternate emergency contact is still required.

Parent/guardian First Name*

Parent/guardian Surname*

Parent/guardian Email*

Parent/guardian Phone*

Parent/guardian address same as participant address?*

Yes

Outside UK?

Parent/guardian Street Address*

Parent/guardian City*

Parent/guardian County*

Parent/guardian Post Code*

Parent/guardian Country*

How did you hear about the retreat?*

What is their name?*

What yoga studio?*

What magazine?*

What is their name? What school do they work at?*

Which social media service?*

Please explain where you heard about this retreat:*

Many of our participants need support getting to and from the retreat or would like to carpool. Your generosity in offering a ride is greatly appreciated. We will share contact information for ride sharing, so interested parties can coordinate directly. Please specify whether you can offer a ride, whether you need a ride, or neither.*

Ride to:

Ride from:

Please describe your experience with meditation:*

What is your motivation for coming on this retreat?*

Please describe some of your strengths and things you like about yourself:*

What are some things that you do to help you cope with tough times?*

Please describe any present circumstances that might be placing you under additional stress or make meditation difficult for you (e.g. loss of loved one, leaving home, divorce, etc.)*

Learning about the diversity of our applicants helps us create an environment that supports every teen on retreat. Please check all that apply to you:

Please describe how you self-identify:

Please describe any special medical needs or conditions (including allergies to medications) or a history of physical illness or limitations:

Would any of these conditions be aggravated by or interfere with sitting or walking meditation?

Yes

I don't know

N/A

Please indicate any food allergies. We can accommodate most severe and common allergies and intolerances but not all. Please include severity below:

Have you been in therapy in the last two years?*

Yes

Please explain why (e.g. diagnosis, treatment, dates):*

Are you currently in recovery from addiction to drugs or alcohol?*

Yes

For how many months/years?*

We require that you have at least 3 months of sobriety before the start of the retreat in order to attend.

Do you currently smoke?*

Yes

Would you be willing to quit smoking during the retreat?*

Yes

If you smoke and are willing to quit during this retreat (strongly recommended but not required), we will offer you support—we deeply support that people overcome addiction to nicotine as soon as possible.

We have a zero tolerance policy for the use of illegal drugs and alcohol during the retreat by anyone, including staff and participants.

Have you answered all the questions above honestly and not left out important information?*

Yes

Is there anything else you think we should know in order to support you on retreat?

Please acknowledge that you have completed this application form in its entirety.*

I acknowledge that I have completed this application form in its entirety.

To be completed by parent/guardian (applicant if 18 or over)

Does your child (applicant if 18 or over) have any allergies?*

Yes

Please list all allergies, including severity below:*

According to UK law, iBme UK requires all participants to hand in medication to the health coordinator at the start of the retreat. These medications will be given to the participants based on their prescription, for the participant to self-administer. We require written parental permission (see below) for all medication taken while on retreat. All medication must be brought in a correctly labeled pharmacy or manufacturer’s medication container. Medications will not be accepted in containers such as plastic bags or daily pillboxes. Medications will be distributed exactly as the container instructs. Please send enough medication to cover the duration of the retreat. All medications will be kept by an iBme UK staff member in a secure location and returned to the participant at the close of the retreat. **Inhalers/Epi-pens: If your child has asthma or life-threatening allergies, with your permission, they will be allowed to keep these on their person at all times. However, we request that you also send in an extra inhaler or Epi-pen to be kept with iBme UK staff as an additional safety precaution.

Is your child (applicant if 18 or over) currently taking any medications?*

Yes

Please list all medications here. Please include the Route, Strength, Dose, and Time(s) to be taken for each medication.*

Please grant permission*

I (signature below) grant permission for my child (applicant if 18 or over) to self-administer their own medication (listed above) while on the iBme UK retreat. Additionally, I agree to release, indemnify, and hold harmless Inward Bound Mindfulness Education UK (registered as Youth Mindfulness Education CIC) and all iBme UK employees, volunteers, and other agents, from and against any claim either my child (applicant if 18 or over) or I may have as a result of any act or omission, which may arise out of this authorisation.

Parent/guardian/applicant signature*

Date*

The fee for this retreat is 1% of family income, capped at £800
There are assisted places based on family income
Required Deposit: 30% of total payment or min. of £35

iBme UK is committed to keeping our retreats accessible to all young people who would like to attend. Our fee structure has been developed to accommodate a wide range of family incomes. The maximum fee reflects what it actually costs per participant to run the retreat. We ask that you pay the fee amount of 1% of annual family income. Your ability to pay the 1% fee allows us to continue to offer this unique payment scale. We aim to not turn anyone away for lack of funds and your support allows this to happen.

Please specify your payment:*

I will pay the full fee. (£800)

I will pay 1% of my family income.

Please enter your household income: *

Discount code (if any):

Would you like to be added to our mailing list to receive updates and news?*

Yes

This field should be left blank

Cancellation Policy

If you cancel more than 3 weeks before the start of the retreat, your payment will be refunded minus a £80 administrative fee and the deposit. We cannot offer refunds for cancellations made less than 3 weeks before a retreat because of our commitment to the retreat centre. There is no refund if you decide to leave the retreat early.