Kailash with Mohanji

A warm welcome to you for the Kailash Yatra with Mohanji 2018 pilgrimage! We sincerely request you to complete the following questionnaire. The answers will help us to organize your Kailash Yatra in an effective way and serve you better. Please be assured that, your answers will be kept confidential.

Kailash Track (required)

A. PERSONAL INFORMATION

First and Last Name (required)

Date of birth (required)

Gender (required)

Phone/Mobile with country code For e.g., +91 for India (required)

Email address (required)

Passport photo - only JPEG, JPG or PNG files < 2MB. Preferred format for filename (required)

Mailing Address (required)

Nationality (required)

Country of residence (required)

Country of Birth (required)

PASSPORT INFORMATION (Important)

Please check whether you have
A Valid PassportApplied for Passport RenewalApplied for New Passport

If you have a Valid Passport with more than 6 months of validity, enter the following details EXACTLY as per your Passport

Given (or) First Name (required)

Surname (or) Last Name (required)

Nationality (required)

Passport Number

Passport Issue Date

Passport Expiry Date

EMERGENCY CONTACT INFORMATION (Important)

If the applicant is minor, under 18 years of age, the emergency contact person must be a parent or guardian.

First and Last Name (required)

Gender (required)

Phone/Mobile with country code For e.g., +91 for India (required)

Email address (required)

Relationship (required)

Mailing Address (required)

Country of residence (required)

B. FOOD CHOICES

Only vegetarian food that is generally low in spices and oil is served during the Yatra. Food is prepared according to the climactic conditions and also to help adapt to high altitude.

Do you have any specific preferences for food? [For e.g., no onion or garlic, gluten free diet, etc]

Do you have dietary restrictions? If yes, please specify.

Do you have any known food allergies?

C. HEALTH CONDITIONS

Please let us know about you are suffering from any major health problems, genetic disorders or any kind of psychosomatic illnesses (including any hospitalisation and/or surgery; heart conditions; high blood pressure; shortness of breath/breathing difficulties; stroke; diabetes; epilepsy; hernia; glandular fever, rheumatic fever; dizziness or fainting; arthritis; asthma; cramps muscular pain any pain/injuries to the neck, back, knees or ankles). Please name the issue and also mention the medicines you are currently taking for them

Blood Pressure (High or Low)

YESNO

If YES, please share the details

Diabetic or Impaired Glucose Intolerance

YESNO

If YES, please share the details

Shortness of breath/Breathing difficulties/Palpitation

YESNO

If YES, please share the details

Heart conditions (Heart Attack/Cardiac Arrest/Heart Surgery/Angioplasty)

YESNO

If YES, please share the details

Dizziness or fainting

YESNO

If YES, please share the details

Lung Disorders (Asthma/Bronchitis/Sinusitis/Persistent Cough/Tuberculosis)

YESNO

If YES, please share the details

Cramps/Muscular pain/Swelling of feet

YESNO

If YES, please share the details

Stroke/Seizures/Epilepsy/Neurological Problems

YESNO

If YES, please share the details

Depression/Anxiety/Mental Disorders/Treated by Psychiatrist

YESNO

If YES, please share the details

Varicose Vein/Back Pain/Arthritis/Joint Problems

YESNO

If YES, please share the details

Pain/injuries to neck, back, knees or ankles

YESNO

If YES, please share the details

Recent hospitalisation and/or surgery

YESNO

If YES, please share the details

Do you have any other illness? Are you taking any medicines for them? If YES, please name the disease and also mention the medicines you are currently taking for them (required)

Do you have frequent backaches, knee aches or headaches(required)

Are you suffering from motion sickness? (required)

Do you have any known drug allergy? If yes, please specify.(required)

Do you smoke or consume alcohol/tobacco products/addictive drugs on a regular basis? (required)
If yes, please specify

D. PHYSICAL FITNESS

Your physical fitness is important to face the adverse weather and altitude conditions during the Yatra. However, your conviction and faith will matter more.

What is your Height (in cm)?

What is your Weight (in Kgs)?

What is your Blood Group?

How often do you exercise?

How often do you practice Yoga?

How often do you practice Pranayam (breathing exercises)?

How do you rate your consistency in spiritual practices?

LowMediumHigh

E. GENERAL INFORMATION

How did you hear about this program? (required)

Have you ever participated in any other programs or activities of Mohanji Foundation or any other Master or organization? If yes, please specify what kind of activities and for how many months/years.

What do you expect from this pilgrimage? What do you hope to gain from it?

Would you like to volunteer for
PhotographyVideographyFirst-AidTrekGeneral Organizing

F. SPIRITUAL JOURNEY AND DESTINATION

Kindly write a short essay about your spiritual journey and what destination you hope to reach (minimum 200 words). Please note that there is no right or wrong answer. We simply would like to get to know you better. (required)

G. SPONSORSHIP

Are you sponsoring yourself totally or you are partly sponsored by someone within or outside the group?

Are you sponsoring someone for the Yatra in this group? If YES, then how many?

Would you like to help someone to join this Kailash Yatra with Mohanji 2018 who is in need for the financial support?

H. CLOTHING SIZE PREFERENCE

Track suit
SMLXLXXL

Track Pant
SMLXLXXL

NOTES AND RECOMMENDATIONS

  1. Kailash Yatra is known for its unpredictability due to sudden climatic changes at high altitude. This may adversely affect the Yatra and it is beyond the control of the organizers. We regret that in such a case the cost is not refundable.
  2. This Kailash with Mohanji pilgrimage is not advised for pregnant women and those suffering from chronic health problems like epilepsy, heart ailment, psychological problems and major physical disabilities.
  3. We would strongly recommend that you consult with a physician to help you take a studied call on your health condition vis-a-vis high altitude environments before you embark on the trip.
  4. Your safety will always be our highest concern. Based on the health/medical details provided in your application form, the Kailash with Mohanji team may request you to furnish a provisional clearance from your doctor and/or, optionally, a go-ahead from your next-of-kin as a pre-condition for registration.
  5. Have you recently checked your hemoglobin? If not, please check it.
  6. Please consult your doctor and have supplements for iron, vit B12 and calcium for a month or two before the Yatra. It will be useful.

TERMS AND CONDITIONS

  I hereby confirm that I have personally filled all the information correctly and consciously, and I am carrying full responsibility for attending this pilgrimage.

  I take full responsibility for my physical condition including consulting with a medical practitioner to evaluate my health condition vis-a-vis high altitude environments. I confirm that Brahmarishi Mohanji, Mohanji Foundation, any of the people or venues associated with Mohanji will bear no liability should any medical matter arise and I shall be financially responsible for any consequential medical, evacuation, accommodation or related expenses

  I hereby agree that Brahmarishi Mohanji, Mohanji Foundation, any of the people or venues associated with Mohanji shall not be responsible for any of the possible consequences related to the attendance to the pilgrimage. I hereby agree Brahmarishi Mohanji, Mohanji Foundation, including all organizers and assistants associated with Mohanji Foundation will not be held responsible for any loss or damage whatsoever and I waive all rights to compensation in case of injury or loss.

  I accept that Brahmarishi Mohanji, Mohanji Foundation, any of the people or venues associated with Mohanji will not be held accountable for any changes due to change of official rules and laws of Tibet. Moreover, I agree that they are not liable for any changes in the itinerary due to unavoidable circumstances such as landslide, road blockage, flood, snow, political unrest, cancellation of flight, sickness and accidents. I hereby agree to pay any extra cost arising due to the above circumstances on the spot.

  I understand that the registration is complete only after paying the full fee and that the contribution is non-refundable and registration is non-transferable. Likewise, any changes in the schedule of the program by the Mohanji Foundation will be notified in advance. In case of cancellation of the program, attributed to any cause that is beyond the reasonable control, including natural disasters like floods, fire, tempest or conditions caused by men, such as war, revolutions etc. the program charges will not be refundable.

  I welcome supporting Mohanji Foundation and its associates by enabling them to use my images, if necessary, and video footage in its publications and media placements. Should I wish to be excluded, it is my responsibility to inform Kailash with Mohanji organisers at the time of registration.

DISCLAIMER

Please review if all mandatory questions are answered before you submit your application.