Sesshin Registration
By completing this registration you are indicating your intent to participate in sesshin at the Chicago Zen Center, and unless you receive notification to the contrary, you should plan on attending. If your plans change, notify the center ( as soon as possible. Payment of sesshin fees may be made by cash, check, or via the "Donate" button on the "Support" page of the website. If you make electronic payment, please note that it is for sesshin when prompted.
Name *
Have you been completely vaccinated for COVID-19? Only those vaccinated may attend. *
Registering for (month) *
Attending *
If part/short time, give days and times
Have you, in a formal ceremony, become the student of a Zen teacher? *
If yes, give the teacher's name
Is this your first sesshin at the Chicago Zen Center? *
If yes, have you attended sesshin elsewhere?
If yes, where?
Best Phone Number *
Email Address *
Home Address *
Emergency Contact Name, Relation *
Emergency Contact Phone *
LIst all current medical and psychiatric conditions (confidential, for emergency purposes only) *
List all current medications *
Are you in psychotherapy? *
Will you need a chair during formal rounds? *
Major surgeries in the past 5 years *
List all food allergies *
Are you a member of the Chicago Zen Center? *
Payment may be made by cash or check at the Center, electronically via Zelle or PayPal to, or via the "Donate" button on the "Support" page of the website.
Will you need assistance from the Abbot's Fund to help meet the cost of sesshin?
Clear selection
Would you like to contribute to the Abbot's Fund to assist those who otherwise cannot afford sesshin?
Clear selection
If yes, how much would you like to contribute at this time? (Include with your sesshin payment)
"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" *
Never submit passwords through Google Forms.
This form was created inside of Chicago Zen Center. Report Abuse