Vipassana Meditation

As taught by S.N. Goenka
in the tradition of Sayagyi U Ba Khin

Application Form — Children
18 May, 2024 — 18 May, 2024 | Deganya Bet, Israel
Children and teenagers introduction (Israel)

Instructions:

  1. Student must complete all questions on this page.
  2. Parent or Guardian must complete all questions on the Parent Information, Medical and Emergency, and Permission pages.
STUDENT INFORMATION
Given / First name in English Given / First name in English / Roman script
Surname / Family / Last name in English Surname / Family / Last name in English / Roman script
Select Gender Please select your gender

Date of birth
Standard / Grade
Primary Language Native Language or language you are most comfortable with
Have you ever been to a Children’s or Teens’ Anapana Meditation Course with Mr. S.N Goenka or any of his Children’s Course Teachers before?

If yes, how many?
What made you want to participate in the course?
What do you expect to get from this course?

 
Please write a little bit about yourself
and what you like to do:
Anything you wish to add to the above information?
Do you want to come to this course?

Your Signature
Today’s Date