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Retreat Packet

The Retreat Packet should be completed AFTER submitting the Inquiry Form. After the Inquiry has been approved, the Retreat Packet must be completed to confirm your stay with us. Please direct any questions to [email protected].

KTTG RETREAT PACKET

Please review the entire packet to ensure you have all the necessary information, BEFORE completing the form. You must complete the entire form in one session.

PERSONAL CONTACT INFORMATION
Your Name*
First Last
Your Email*
Cell Phone Number*
Alternate Phone
Your Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Vehicle year, make, model, color*
Vehicle license plate number*
EMERGENCY CONTACT INFORMATION
Person to contact in case of emergency*
First Last
Relationship*
Contact Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
- Contact Email*
- Contact Phone Number*
- Alternate Phone
- Cell phone
  - This is a cell phone
MEDICAL INFORMATION
Do you have any health problems that may affect your retreat?*
- Yes
- No
Please describe the health problems that may affect your retreat:*
Do you have allergies?*
- Yes
- No
Please describe your allergies:*
What is your age?*
Are you allergic to any drugs?*
- Yes
- No
Please describe your drug allergies:*
Are you currently taking any medications?*
- Yes
- No
Please describe the medications you are taking:*
Your doctor's name:*
Doctor's phone number*
RETREATANT RESPONSIBILITIES
In order for us at KTTG to help insure your safety during your off-grid retreat, we ask that you initial the following:
The land*
- I understand that the cabins are located on private land which has public access, and I agree to notify KTTG staff and/or authorities should I spot any concerning wrongful activities.
Wildfires*
- I will report any wildfires, distant or near, which I may see while on retreat. In case of emergency the area around the stupa is a safe zone
Retreat guidelines*
- I will stick to my retreat guidelines agreed upon with KTTG retreat staff.
How often will you need to go to town during your retreat (e.g. number of times per week or per month)?*
For what purpose(s) will you need to go into town?*
Notifying the retreat coordinator*
- I will notify the Retreat Coordinator if I need to make changes in leaving the premises. We do not allow daily commuting from the cabins.
1. Battery maintenance
2. No use of appliances not supported by solar system
3. Refrigerator on/off
4. Woodstove operation and safe disposal of ashes
5. Propane tank operation and changing
Honor guidelines*
- I will honor the maintenance guidelines for my cabin to the best of my abilities: I will call the Coordinator for assistance if I am unsure.
Contacting my teacher*
- I will contact my teacher/Lama or person authorizing my retreat should I feel insecure about the way my retreat is going. Alternatively, I will request retreat guidance from Lama Ann.
Name of my teacher*
Teacher's phone number*
RELEASE OF LIABILITY
Karma Thegsum Tashi Gomang
PO Box 39
Crestone, CO 81131
kttg.org
WHEREAS I am about to engage in a retreat at a retreat cabin on the Karma Thegsum Tashi Gomang/Karma Triyana Dharmachakra property in Crestone, Colorado during the dates of
Retreat Start Date (MM/DD/YYYY)*
MM slash DD slash YYYY
Retreat End Date (MM/DD/YYYY)*
MM slash DD slash YYYY
AND WHEREAS I am doing so entirely upon my own initiative, risk and responsibility.
Therefore, in consideration of permission extended to me by Karma Thegsum Tashi Gomang through its officers and agents to do this retreat, I do hereby, for myself, my heirs, personal representatives and assigns, remise, release, and forever discharge from Karma Thegsum Tashi Gomang and all of its officers, agents and employees, acting officially or otherwise, from any and all claims, demands, actions or causes of actions on account of any injury to me or my property or my death, which may occur from any cause during my retreat or in connection with any activities incidental thereto, and I further do hereby, for myself, my heirs, personal representatives and assigns, remise, release, forever discharge and agree to hold harmless and to indemnify and defend Karma Thegsum Tashi Gomang and all its officers, agents and employees, acting officially or otherwise, against any action or demand by any of my children, or by any other person or persons for damages on behalf of such children. I further authorize Karma Thegsum Tashi Gomang, its officers, agents and employees to arrange emergency medical care for me should it become necessary to do so in the event of personal injury to me. I also undersand that KTTG may need to cancel my retreat due to unforeseen circumnstances, either prior to or during my retreat.
Acknowledgement*
- I acknowledge that my typed signature below constitutes a legally binding agreement of the release of liability presented in this document.
Digital Signature*
Signed on: 05/28/2023
Newsletter
- Yes, please subscribe me to KTTG news and updates.

Helpful Links

Directions to Tashi Gomang Stupa
Friends of Karmapa News
Reservation Inquiry
Retreat Packet
Image Credits
Contact

Directions to Tashi Gomang Stupa
Friends of Karmapa News
Reservation Inquiry
Retreat Packet
Image Credits
Contact

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