Spiritual Retreat 2024 Registration Form

This form will take 10 minutes to complete.

Please have your Health Card and Passport information available.

Information About You

First name*

Last name*

Address*

Contact phone number*

Primary Email Address*

Your Birthday*

Gender Identity*

The bus will pick up participants from two locations. Which location would you prefer?

Etobicoke, Ontario

Niagara Falls, Ontario

Health Information

Ontario Health Card Number*

If you do not have an Ontario Health Card, in the above space, please describe what health coverage you have in Ontario.

Travel Health Insurance is mandatory for all participants. Please buy insurance ONLY after your registration is confirmed on Sept 26. Participants without proof of Insurance will not be allowed to board the bus. *

I am in stable health to make this trip*

List food, environmental or drug allergies below:

Describe any health conditions or concerns you would like us to know about.

I use the following walking aids*

None

Cane

Walker

Other

I need assistance to board and disembark from a bus*

No, I am independent

I need one person to assist me

Other

Preferences

Do you eat dairy products, such as milk, paneer, cheese, yogurt?

Yes

If the bus is delayed, would you accept having dinner after sunset?

Yes

IMJM may arrange a 1 hour tour of a Farm Sanctuary (Goshala) which is located halfway to Siddhachalam. This tour involves walking 1.5 km including walking up a hill. Will you be physically able to participate such a tour at a slow pace ?*

Yes

I am not sure

Optional: The cost of the Farm Sanctuary Goshala tour is $1500 for the entire bus. Would you like to donate part of this cost (a tax-deductible receipt will be provided)? If YES, we will contact you to discuss.

Yes

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IMJM Canada

Toronto, ON

info@imjmcanada.org

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