Temple of Tantra & School of tantra
ADMISSIONS APPLICATION

Please complete the following application before admission to any School of Tantra, Temple of Tantra & Tantra Theosophical Society programs, events, classes, educational programs, dating groups, workshops, seminars, support groups or private sessions. Use a separate paper to answer longer questions and write N/A after questions that are not applicable to you. Each member of a couple must complete a separate form. Youíre not required to answer all the questions; however, the more you tell us about yourself, the better weíll be able to help you. Please answer a minimum of 20 questions. We have groups, sessions and classes for all relationship structures, styles and sexual orientations. We want to place you in the appropriate groups/classes and/or private sessions so you have the best possible experience, learn all you wish, accomplish life goals, experience transcendence and bliss.

Name (first, last, middle) ___________________ Title __________, Temple Name _________________

I am: (check/answer all that apply)

___ Male ___ Gay/Lesbian ___ Bi-Curious
___ Female ___ Bisexual ___ Curious about Lifestyles
___ Couple ___ Heterosexual ___ Dom
___ Divorced ___ Open Marriage/Relationship ___ Polyamorous
___ In Relationship ___ Monogamous ___ Playcouple
___ Married ___ Swinger/Lifestyler ___ Sub
___ Separated ___ Celibate ___ Switch
___ Widowed ___ Transgendered ___ Transvestite
___ Single ___ Married & Miserable ___ Other (describe)

___ Iím in a relationship and have permission from my partner to attend these sessions
___ Iím here to learn skills to enhance and improve my current or future relationships
___ Iím seeking a relationship and wish to learn how to attract a lover and maintain sacred partnership
___ Iím hiding this experience from a significant other and wish to explore this.
___ Iím here without my partner and wish to learn how my partner can be motivated to come to class.

Birth date: Month ____ Day ___ Year ____
(Note: You must be 18 or older to attend our classes and events. Government approved ID showing proof of age required).

Email _________________________________    Telephone: Home (____)_______________________

Work Phone: (____)_______________________   Cell Phone: (____)_______________________

Address: Street _______________________________ City: _________________________________

State/Province: ___________________________ Zip: ______________ Country: __________________

Occupation ____________________________ Are you employed by a law enforcement agency? Y/N ___

If visiting Maui, when did you arrive? _______ When will you depart? ___________

I live on Maui ______ full time, _____ months a year Iím moving to Maui on ___/____/___

I visit Maui ______ times every _______ years for _____ weeks or ______ months

1. Describe your existence - your qualities, traits, characteristics and challenges.

2. What would you like? (If more than one apply, number in order of preference).
_____ celibacy
_____ committed, exclusive, living together, primary relationship, one to one
_____ committed, exclusive, living together, primary relationship
_____ committed relationship polyamory (more than one)
_____ community - non sexual
_____ community - sexual
_____ discreet affair
_____ fetish (please describe _______________________)
_____ group marriage (many people committed to each another)
_____ group lovemaking
_____ intimate network (group of lovers that all know one another or know of one another)
_____ line marriage (committed group, all ages)
_____ living alone
_____ living together
_____ marriage
_____ menage a trois (three way lovemaking)
_____ monogamy (married to one person)
_____ mono-poly (polyamorous couple who live together, date others as a pair)
_____ no definition, decide whatíís right in the moment
_____ one on one sex
_____ playcouple (committed couple who play sexually with other singles and couples)
_____ polyandry (one woman, many men)
_____ polyamory (loving more than one in an intimate relationship)
_____ polygamy (one man, several women)
_____ polyfidelity (closed circle of sexual intimacy)
_____ open relationship
_____ open marriage (married to one person, dating outside of marriage)
_____ serial monogamy (dating one at a time, for a limited time)
_____ single and dating (one person at a time)
_____ single and dating (more than one person at a time)
_____ swinging/lifestyles (sexual episodes)
_____ tantra/tantric (sacred sexuality)
_____ triad (committed threesome)
_____ uncommitted
_____ other (please explain) _________________________

3.    Do you have any experience with tantra? If so, please describe
3A. If you are male, have you mastered ejaculatory control?
3B   If youíre female, do you have ejaculatory (amrita) orgasms?
3C.  How old were you when you first became sexually active?
3D.  What did you do?
3E.  Have you ever been sexually abused or molested?  ______
3G.  If so, have you ever gone to counseling?  __________
3H.  Are you currently sexually active?  ___________
3I.   What do you like to do most when you have sex?
3J.   What do you like to do most when you make love? 
4A. Do you smoke?               If so, how much?                  What do you like to smoke?
4B. Do you drink alcohol?               How much?                 What is your favorite drink?
5.   What attracts you to the School of Tantra events and classes?
6.   Do you hope to find a date or connect with someone at this party, group, seminar or event?

6A. If yes, Iím seeking:
___ single man; _____ single woman; _____ couple; _____ triad; _____ foursome; ______ group
___ to improve and enhance my current relationship

7.   Whatís your current relationship status?
7A. 
If you're in a relationship, how long have you been involved with your partner?  ______ years, _____ months
7B.  If you're currently single, have you ever been married?  Y/N __
7C.  If you've been married, how many times have you been married? 
7D   If you've ever been married, for how long?  ________    Are you still together?  Y/N ____
7E.   How long did your longest relationship last?
7F.   If you're not longer with a partner, what happened that you're now apart?  _______________
7G.  How many relationships have you had that lasted more than six months?
7H.  Does your partner have parents who are alive? 
7I.   If so, what is your relationship like with your inlaws?
7J.  Do you and your partner fight?
7K.  If so, what do you fight about?  What are your main issues?
8.     Are you happy?            To what degree?
10.   If youíre not happy, what do you seek?
10A. Have you ever done psychotherapy or counseling? 
11.   Are you and your partner(s) sexually active? _______ If not, is there a reason? Please explain.
12.   I want to be involved with my partner(s): _____ full time, ____ weeks or _____ months a year
13.   What are your attitudes toward nudity?
14.   Would you be a) comfortable or b) uncomfortable with optional nudity at an event you might attend?
15. What are your attitudes towards sexual behavior, orientations or relationship structures different than yours?
16. Describe your boundaries and limitations around sexual interactions with people you just meet (like, for instance, the people who come to the workshop).
17. Do you have children? ____ If so, how many? ______  
17A. What are the ages and sex of your children?   
17B.  Do your children live with you? _____     Do you share custody with an ex? _______
17C.  Do you have any stepchildren?  _____   What is your relationship like with them?
18. Do you want children _____ If so, how many children do you want?______
19. Do you have pets? _____ If so, how many? ______ What kinds of pets?
20. Do you want pets ? ______ What kind of pets do you want? _____________ How many? _____
21. Who was in charge of you when you were little?
21A.  Are your parents/caretakers still alive?  _____
21B.  Describe your relationship with your parents/caretakers when you were growing up.
21C.  Describe your current relationship with your parents.
22. If you were raised by a single parent, how did that affect you?
23. What did you lack in a parent that you would like to find in a lover?
24. How many siblings did you have?
25. What was your place in the birth order?
26. How did your place in the birth order affect you?
27. Describe the model of relating your parents showed you.
28. What did you think of your parents and the way they modeled relating?
29. Of what they showed you, what would you like to keep, discard or modify?
30. Describe two critical events in your growing up that affect you to this day.
31. What was the cumulative effect of your childhood on who you are now?
32. Describe two peak events from your past that affect you to this day?
32A.  What hurt you when you were growing up?
32B.  What hurt you in past relationships?
33. What are the different roles or aspects of your personality that you must balance?
34. Imagine (or remember) a pastlife you had. What scripts from that life still run through your current existence?
35. What were the religious or spiritual practices that you were taught when you were young?
36. Did you follow those practices or rebel against them?
37. What are your religious and spiritual beliefs and practices now?
38. How do you follow your religious and spiritual practices?
39  Describe your physical appearance. Attach photos, several if possible, to show your many moods.
40. Height ____________ Weight _____________ Body Type ____________
41. What else would you like to tell us about your physical self:
42. Do you have any physical challenges and if so, do you need any special considerations for these challenges?
43. Describe your Personality:
44. What are your best qualities?
45. What are your faults?
46. Are you a jealous person? If so, how do you handle jealousy?
47. Describe an incident where you were jealous
48. How did you resolve your jealousy?
49. What are your interests?
50. Describe your boundaries:
51. Describe your limitations:
52. Describe your expectations:
53. Describe your desires:
54. Describe your fantasies:
55. Do you have any fetishes? If so, please describe
56. Do you read? If so, what are your favorite books?
57. Do you watch television? If so, what are your favorite shows?
58. Do you like movies? If so, what are your favorite movies?
59. What kind of music do you like?
60. What do you seek in relationship?
61. What do they look like?
62. Describe their personality:
63  What do you do when you notice someone that youíre attracted to?
64. What are the qualities of your ideal mate?
65. What are their interests?
66. If everything turned out the way you wanted, what would that look like?
67. Describe your current sexual or intimate relationships:
68. Please tell us anything else about yourself that you think would be relevant for us to know:

What would you like to accomplish in your session?_________________________________________________________________________________

___________________________________________________________________________________

Do you have any concerns or issues we should know about before your session?

__________________________________________________________________________________

__________________________________________________________________________________

___ I agree my purpose in Temple is to seek knowledge of my soulís energy expression. I understand that the sensitivity and personal nature of the work requires a full commitment on my part as well as my healer, to trust one another as fellow Seekers of body wisdom. I agree that I need not leave my primary faith to explore tantra, the all-is-one nature of existence.

___ I pledge that I shall not receive or give any type of therapeutic massage during my sessions at the Temple. Tantric Touch and Whole Body Healing are offered for physical relaxation.

___ I pledge that I shall not receive or give any type of sexual gratification in exchange for money during my session. I offer financial support in gratitude for what unfolds in sessions as a consensual exchange between self-sovereign to expand knowledge of life energy, soul and body.

___ My Healer / Guide and I shall hold in privacy and sacred trust the information shared during our session and shall not discuss any details of our experience outside the Templeís transformation chambers.

Please Check All That Apply: At this point I consider myself a:
___ Guest (to satisfy curiosity)
___ Seeker (to find something that is missing in my life)
___ Initiate (to continue learning mysteries)
___ Priest/Priestess, Healer, Teacher (to expand my own practice)
___ Double Agent (to uncover the truth of temple teachings, sacred sexuality & life forces as it relates to established        social moires and regulations)

I am interested in the following (check all that apply)

___ Active Listening
___ All Chakra Yoga
___ Alternative Lifestyles Counseling
___ Ancient Anthropology
___ Bereavement Therapy
___ Childhood Regression
___ Couples Counseling
___ Cultural Conditioning Reprogramming
___ Delight Dionysius
___ Divine Pairs Couples Tantra
___ Dreamwork
___ Ejaculatory Control
___ Erectile Dysfunction
___ Existential Analysis
___ Extraterrestrial Contact
___ Family of Origin Reprogramming
___ Female Ejaculation
___ Full Body Bliss
___ Gestalt Therapy
___ How to Really Love a Man
___ How to Really Love A Woman
___ Holotropic Breathwork
___ Hypnotherapy
___ Imago Therapy
___ Increasing Orgasmic Potential
___ Life Review
___ Life Between Lives Hypnotherapy
___ Non Violent Compassionate Communication
___ Pastlife Regression Therapy
___ Personal Growth Coaching
___ Polyamory Counseling and Coaching
___ Premature Ejaculation
___ Primal Therapy
___ Private Yoga Instruction
___ Prostate Health
___ Refining Relationships
___ Religious Deprogramming
___ Roleplaying
___ Shamanic Journeys
___ Share Shiva & Shakti
___ Spirit Releasement Therapy
___ Spiritual Emergence
___ Spiritual Emergency
___ Tantra Certification
___ Tantra Ordination
___ Tantra for One
___ Tantra/Sacred Sexuality Coaching
___ Tantra/Sacred Sexuality Counseling
___ Tantra/Sacred Sexuality Education
___ Whole Body Healing
___ Vini Yoga
___ Voice Dialogue Centering
___ Yoga
___ Other (please describe)
 

Would like to receive our newsletter? If yes, list email here: ________________________________
(Note: your information is confidential and will not be shared with any other group or individual)

I would like to attend sessions/classes: ___ Daily, ___ Weekly, ___ Twice a month, ___ Monthly
Every other month ____ Other _______________

What is your budget for private sessions, workshops, events? _________________

Iím interested in the following:
___ Private Sessions, ___ Workshops, ___ Conferences, ___ Events, ___ Groups, ___ Parties
___ Temple Services, ___ Personal Growth, ___ Healing, ___ Education, ___ Spiritual Development
___ Certification Programs, ___ Counseling/Coaching/Therapy
, ___ Group Events, ___ Private Sessions
___ All Day Events, ___ Two Day Events, ___ Week-long Events, ___ Week-End Events

___ Morning, __ Afternoon, __ Evening, ___
___ Mon, ___ Tues, ___ Weds, ___ Thurs, ___ Fri, ___ Sat

SCHOLARSHIP PROGRAM: I would like to sponsor:
___ single woman, ___ single man, ___ couple, ___ I can contribute $__________ towards their expenses

___
I want to help them with: ___ Tuition, ___ Transportation, ___ Meals, ____ Accommodations
___ I need a Scholarship and/or a sponsor:
___ I need help with: ___ Tuition, ___ Transportation, ___ Meals, ____ Accommodations
___ I can contribute $__________ towards my own expenses

Are you a current School of Tantra/ Temple of Tantra Member? Y/N ____
If so, when did you register? ______________ , When does your membership expire? __________

An orientation interview is required before admission to any of our programs-groups, classes, sessions or events. The Annual School of Tantra/Temple of Tantra Membership Fee is $150 per single or couple which includes
your application review, orientation interview/tantra basic class or private tutorial. Allow 60-90 minutes for your session.

___ Annual Life Review and Introspection
___ Polyamory 101

___ How to Really Love A Woman
___ Relationship Coaching or Counseling
___ How to Really Love A Man
___ Relationship Counseling
___ Orientation Interview/Tantra Basic Class
___ Personal Growth Session

Date/Time I want my appointment _________________ AM/PM, ____
___ Phone session, ___ In Person, I prefer: Morning ___, Afternoon ___, Evening
___ Monday, ___ Tuesday, ___ Wednesday, ___ Thursday, ___ Friday, ___ Saturday, ___ Sunday

I want to attend: ___ by myself, ___ with __________________________ (name of person)

I would like my next session/class after my orientation or annual review interview orchestrated as follows: Practitioner (s), Teachers: ________________
___ Let the Temple board select the best teacher

Type of Session:_______________

___ Let the teacher decide which classes I need to learn next

___ I am interested in correspondence/distance learning classes/courses

Payment Method: ___ Master Card, ___ VISA, ___ Discover, ___ American Express, ____ Cash, ___ Check *(note: checks must be received 7-10 days before class/group/program/event in order to clear the bank).

___ I wish to make a donation to the Temple for $________

___ I need a receipt so I can receive 501(c)(3) non-profit Temple of Tantra Church deduction on my tax return

Credit Card Number _______________________ Expiration Date _________ Code on back _____

Signature _________________________________ Name on card __________________________

Mail this form along with a copy of your ID showing proof of age and payment to the address below so that we may review it before your appointment. Call 808-244-4103 to schedule your appointment or email us at schooloftantra@aol.com with your request and weíll get back to you ASAP.

SCHOOL OF TANTRA/TEMPLE OF TANTRA
1371 Malaihi Road, Wailuku, Maui, HI 96793
808-244-4103, 808-244-4921
www.schooloftantra.com, www.templeoftantra.org
schooloftantra@aol.com, templeoftantra@gmail.com

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WAIVER OF LIABILITY AGREEMENT

I understand that the Temple of Tantra (TOT) /Maui Goddess Temple (MGT) /School of Tantra (SOT) is located in a rustic, hilly and wild area. I and my assignees, heirs, personal and legal representatives, release from liability, hold harmless and will not make any claims (present and future) against TOT, MGT and SOT any of its staff, agents, contractors, guests or volunteers for any physical or emotional injury, including death, that may occur to me and accompanying children, animals or adults at TOT, MGT and SOT including but not limited to slipping and falling, use of any pools or water including infections or drowning and use of any trails; including but not limited to any loss of any kind to my property or vehicle, whether resulting from my own acts, the acts of others, acts of God or from acts of any TOT, MGT and SOT staff, agents, contractors or volunteers. TOT, MGT and SOT is a private, members-only organization and reserves the right to terminate the tenancy of a guest for reasons TOT, MGT and SOT shall deem objectionable.

___ I verify that I am not employed by any law enforcement agencies, massage schools or agencies, nor do I work in law enforcement, massage related or governmental agencies.

__________________________________          ____________________                      ___/___/___
Seeker/Temple Member/Student Signature               Printed Name                                          Todayís Date