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 (contact@chicagozen.org) 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.
Sign in to Google to save your progress. Learn more
Name *
Registering for (month) *
Attending *
Required
If part/short time, give days and times
Are you currently the student of a Zen teacher (having gone through a formal ceremony to that effect)? *
Required
If yes, give the teacher's name
Is this your first sesshin at the Chicago Zen Center? *
Required
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? *
Required
Will you need a chair (or have one available) during formal rounds? *
Required
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 czc.business.mgr@gmail.com, or via the "Donate" button on the "Support" page of the website.
Required
Will you need assistance from the Abbot's Fund to help meet the cost of sesshin?
Clear selection
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 tapped 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
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Chicago Zen Center. Report Abuse