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BZC Sesshin Application
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Email *
First Name *
Last Name *
Age *
Street Address *
City *
State *
Zip Code *
Emergency Contact Name *
Emergency Contact Phone Number *
  Are you a member of Bay Zen Center? *
Have you recently stopped taking any medications? (non-members) *
Sesshin Dates (Select One)                                                 *
If circumstances make it impossible for you to pay in the range stated, please pay what you can. No one is turned away for lack of funds.
Form of Payment *
Please pay as much of the sliding scale as you can afford, as this will support others who cannot afford to attend as well as the center and the teacher. Our intention is to make our offerings available to everyone. We keep our fees as low as possible. Please don’t let financial issues prevent you from attending. No one is turned away for lack of funds
Amount Paid *
Please let us know how much you paid so we can correlate this with payments received.
Do you have any dietary restrictions? (Does not apply when sesshin is on-line.) *
How will you attend? *
Do you need to borrow an oryoki set, or will you bring your own? *
Sesshin Waiver
1. I am aware that certain activities of the sesshin conducted by the Bay Zen Center, Inc (BZC), a nonprofit religious corporation, are physically, mentally, and emotionally demanding and potentially dangerous. I understand that potentially dangerous activities of the sesshin may include heavy lifting. I UNDERSTAND THAT I HAVE THE RIGHT TO REFUSE ANY REQUEST TO DO ANY POTENTIALLY DANGEROUS, OR EMOTIONALLY OR MENTALLY CHALLENGING ACTIVITY.

2. I understand that certain aspects of the sesshin involve a potential risk of illness, death or injury to my person or property. I ACKNOWLEDGE THAT I AM AWARE OF AND ASSUME ALL OF THESE RISKS AND WISH TO PARTICIPATE IN THE SESSHIN.

3. As part of the consideration for my participation in the sesshin, I assume full responsibility for all property damage, death, loss, injury, illness, or any other inconvenience I may suffer, regardless of the cause (including negligence on the part of BZC). I EXPRESSLY AGREE TO RELEASE, DISCHARGE,  AND COVENANT NOT TO SUE THE BAY ZEN CENTER AND ITS AGENTS FOR ANY AND ALL CLAIMS AND LIABILITY ARISING OUT OF NEGLIGENCE ON THE PART OF THE BAY ZEN CENTER AND ITS AGENTS WHICH CAUSES ANY SUCH PROPERTY DAMAGE, LOSS, DEATH, INJURY, ILLNESS OR INCONVENIENCE.

4. As further part of the consideration for my participation in the sesshin, I also agree to indemnify and hold harmless the Bay Zen Center, its agents, and sesshin participants for any liability incurred by any persons as a result of my participation in the sesshin and for all attorneys' fees and costs incurred in establishing the Bay Zen Center's right to indemnification under this Agreement.

5. As a further part of the consideration for my participation in the sesshin, I also agree to indemnify and hold harmless the Bay Zen Center, its agents, and sesshin participants for any emotional, mental or psychological  disturbance or discomfort I may undergo. I understand that my mental and emotional health are my own responsibility, and that the Bay Zen Center has informed me of the necessity that I inform them of any history of instability or therapy, and that it is my responsibility to handle emotional upsets separately from my Bay Zen Center involvement, as a precondition to my being allowed to participate at the Bay Zen Center.

6. I have informed the Bay Zen Center of all medications I take on a regular basis for physical or psychological conditions, and any hospitalization for psychological  reasons.

7. I agree that the terms of the Agreement will serve as an exemption from liability, as an assumption of risk, and as a waiver of all rights under California Code of Civil Procedure Section 377 (the Wrongful Death statute) for my heirs, executors, administrators, and for all members of my family, including any minor children.

8. This Agreement constitutes the entire understanding between me and the Bay Zen Center regarding this matter and supersedes all other oral or written understandings.
By typing my name in the space below, I understand this acts as my signature acknowledging that I have read the paragraphs above carefully, understand fully the contents of each, and sign this agreement voluntarily. *
Date of Signature *
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