Sulzbrunn 2026 Registration

Name

First Name

Last Name

Meditation Practice History

What does your meditation practice look like? Feel free to write something quick and brief or skip this if Upali and/or Tucker already know your practice. Helpful things are: 1) Length of practice history 2) Favorite practice technique(s) and 3) consistency of meditation practice off of retreat (ex. 30 min daily). You can also include any intention or hope that you’re holding for this retreat. We’ll have time to talk about your practice in interviews, but this helps give Upali and Tucker context.

Community Code of Conduct

Tucker and Upali's retreats follow this Community Code of Conduct. You are expected to adhere to it while on retreat. The code is intended to create an environment that is, above all, safe and also deeply supportive of practice. Below are some of the codes that are important to highlight because of their different-from-daily-life and sometimes challenging nature.

I agree to refrain from speaking while in noble silence except in cases of emergency or when necessary (ex. talking with a teacher in an interview, communicating with staff about food allergens, working with a fellow yogi on a task, etc.)

I agree to refrain from cell phone use unless I'm using my cell phone as a clock or flashlight. I agree to refrain from use of computers, tablets, and any other uneccessary electronic devices.

I agree to refrain from reading and writing. The one exception is if you are reading a book that is a manual for meditation (not a general dharma book), and if you are only reading the section of the manual immediately relevant to your technique at the moment.

I agree to abstain from mind-altering substances, unless they are prescribed by a doctor and/or would cause withdrawals if you abstained (e.g. caffeine, nicotine).

I agree to abide by the general code of conduct as it is relevant to this retreat.

Medical History

Do you currently have, or have you in the past been diagnosed with or treated for, any mental health conditions? If you're certain Upali already knows this info about you (eg you've been on a retreat with Upali in the past and this information hasn't changed), it's OK to leave this blank. If you'd rather talk about this privately, please leave it blank and contact Upali and/or Tucker before the retreat starts. Historically, no one has been excluded from Upali or Tucker's retreats based on this information, but it's helpful to know, as it can change the way meditation might affect you.

Emergency Contact

Emergency Contact (First name, last name, relationship)

Emergency Contact

Emergency Contact (phone number)

Waiver

Below is a retreat waiver. Please sign it by typing your first and last name in the box below. The individual electronically signing this form by typing my name (referred to as “I” or “me“) desires to attend a meditation retreat (the “Activity“) provided by Upali Meditation, llc and Upasaka Upali, also known as Paul Peterson and affiliated people and entities, including but not limited to Well Being Retreat Center. All actions I take in connection with such retreat by the Company shall be considered the Activity. In consideration of being permitted by the Company to participate in the Activity, I agree to all the terms and conditions set forth in this document (this “Release“).I agree to personally accept any and all risks associated with this retreat, occurring before, during, or after the retreat. I understand that Upali Meditation, llc and Upasaka Upali, also known as Paul Peterson may suggest a possible carpool choice that I can make. I know that the teacher may not know other drivers or passengers, that drivers and passengers are not affiliated with, agents of, or working on behalf of the teachers, and teachers hold no liability for actions or negligence of drivers or passengers. I am aware that while the Company is taking precautions against transmission of disease, it is of course still possible that I will catch a contagious disease, including Covid-19, while on the retreat, and I personally accept all such risks and release the Company from any claims related to the same. I understand that Upali aka Paul Peterson is working in his capacity as a meditation teacher, not a psychologist, and that he is not providing psychological or medical advice. If I need treatment for mental health concerns or any other reason, I will seek out a healthcare professional licensed in my area. I have sufficiently educated myself and requested sufficient information from the teachers on the benefits and risks of the Activity. I understand that Upali aka Paul Peterson is functioning as a teacher while I rent a room from a facility, and that I am responsible for my own safety and wellbeing. I AM AWARE AND UNDERSTAND THAT THE ACTIVITY IS A POTENTIALLY DANGEROUS ACTIVITY. I ACKNOWLEDGE THAT ANY INJURIES THAT I SUSTAIN MAY RESULT FROM OR BE COMPOUNDED BY THE ACTIONS, OMISSIONS, OR NEGLIGENCE OF THE COMPANY. NOTWITHSTANDING THE RISK, I ACKNOWLEDGE THAT I AM KNOWINGLY AND VOLUNTARILY PARTICIPATING IN THE ACTIVITY WITH AN EXPRESS UNDERSTANDING OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DISABILITY, DEATH, PROPERTY DAMAGE, OR OTHER DAMAGE OF ANY KIND ARISING FROM THE ACTIVITY, WHETHER CAUSED BY THE ORDINARY NEGLIGENCE OF THE COMPANY OR OTHERWISE. I hereby expressly waive and release any and all claims which I may have, or which I may hereafter have, whether known or unknown, against the Company, and its officers, directors, managers, employees, contractors, consultants, representatives, agents, affiliates, owners, successors, and assigns (collectively, “Releasees“), including without limitation Upali Meditation, llc and Upasaka Upali, also known as Paul Peterson, arising out of, related to, or attributable to the Activity, whether arising out of the ordinary negligence of the Company or any Releasees or otherwise. I covenant not to make or bring any such claim against the Company or any other Releasee, and I forever release and discharge the Company and all other Releasees from liability under such claims. This waiver and release does not extend to claims for gross negligence, intentional or reckless misconduct, or any other liabilities not permitted to be released by agreement. I understand that by signing this release, I am waiving any and all claims, of any kind arising out of or attributable to the Activity, including those claims that may be unknown to me, or which I do not suspect to exist at this time. BY ELECTRONICALLY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTOOD ALL OF THE TERMS OF THIS RELEASE AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY FOR CLAIMS, WHETHER KNOWN OR UNKNOWN, ARISING OUT OF THE ACTIVITY.