Sesshin Registration
Name *
Your answer
Applying for (month) *
Your answer
Attending *
Required
If part/short time, give days and times
Your answer
Have you, in a formal ceremony, become the student of a Zen teacher? *
Required
If yes, give the teacher's name
Your answer
Is this your first sesshin at the Chicago Zen Center? *
Required
If yes, have you attended sesshin elsewhere?
If yes, where?
Your answer
Best Phone Number *
Your answer
Email Address *
Your answer
Home Address *
Your answer
Emergency Contact Name, Relation *
Your answer
Emergency Contact Phone *
Your answer
LIst all current medical and psychiatric conditions (confidential, for emergency purposes only) *
Your answer
List all current medications *
Your answer
Are you in psychotherapy? *
Required
Will you need a chair during formal rounds? *
Required
Major surgeries in the past 5 years *
Your answer
List all food allergies *
Your answer
Are you a member of the Chicago Zen Center? *
Payment may be made by cash or check at the Center, or electronically via Zelle or PayPal to czc.business.mgr@gmail.com.
Required
Will you need assistance from the Abbot's Fund to help meet the cost of sesshin?
Would you like to contribute to the Abbot's Fund to assist those who otherwise cannot afford sesshin?
If yes, how much would you like to contribute at this time? (Include with your sesshin payment)
Your answer
SESSHIN AGREEMENT & LIABILITY WAIVER​
"I agree (1) that I will finish the entire sesshin or portion of sesshin for which I have applied, and, (2) understanding that sesshin is a period of strenuous traditional Zen training involving some 10 hours of formal meditation per day during which participants may be frequently struck with the kyosaku (encouragement stick), that neither the Chicago Zen Center nor any of its employees, officers, trustees, or trainees – nor any person acting as sesshin monitor or otherwise supervising, overseeing, or conducting any aspect of sesshin – shall be liable to me or to any other person for any loss or injury suffered by me in connection with my participation in sesshin, whether or not such loss or injury is caused by any act or omission of the Center or of any of the persons specified above."
I agree to the "Sesshin Agreement & Liability Waiver" *
Required
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This form was created inside of Chicago Zen Center.