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Intended arrival date
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Intended departure date
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Purpose of visit
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Recent passport / ID card size photo (file to be in jpg or jpeg format, max 5 MB)
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Full name
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Spiritual name (if any)
Diksha
Mantra
Jignasu
Karma
Poorna
Nil
No, I haven't received diksha
Diksha given by
Gender
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Birthday
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Month
Day
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Marital status
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Present nationality
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Permanent Address
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Email
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Phone number
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In case of emergency, please contact: name, relation, phone number and email.
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Have you stayed at La Vie Est Belle learning center before? If yes, when did you last visit La Vie Est Belle? If no, how do you know of La Vie Est Belle, or are you referred by someone?
*
Have you visited other ashrams or learning center of Bihar Yoga? If yes, please give details about that ashram or learning center.
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List the skills you have to contribute in learning center activities.
Have you ever been convicted of any criminal offence? If yes, give details of offence and sentence.
Do you have any current physical health problems, allergies, illnesses or diseases? If yes, give full details.
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Have you suffered from any major illness in the past? If yes, give full details.
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Do you have any current mental or emotional health issues, i.e. anxiety, panic attacks, depression, etc.? If yes, give full details.
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Do you have a history of any mental health issues, i.e. anxiety, panic attacks, depression, etc.? If yes, please give full details.
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Are you taking any medication/s at present? If yes, give name and for what condition.
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Do you have any dietary restrictions? If yes, give full details.
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