Lodging Request for a CSE Program
CSE's meditation programs offer a sense of spaciousness in a pristine natural environment to restore vitality and bring greater clarity to mind and body. The structure of our programs provide the opportunity to immerse yourself in spiritual practices and directly experience the transformation that is possible as you explore the unfolding of the true Self.

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Email *
First Name
 *
Last Name *
Preferred Name *
Street Address *
City *
State (and Country if outside of US) *
Mobile Phone *
Gender Identity *
Which CSE Program have you registered for? *
Requested Arrival Date *
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Requested Departure Date *
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Any special needs e.g. room preference, dietary restrictions, etc.
Emergency Contact (Name, First & Last) *
Emergency Contact (Phone Number) *
Please provide the name of your medical insurance carrier or if not insured, what emergency provider you would like to use in the event of a medical emergency *
Please list any medical issues in case of emergency *
Please list any prescribed medications in case of emergency *
How would you rate your physical health (excellent, good, okay, poor)? *
If Okay or Poor, please explain any current health challenges and any serious conditions requiring medication and/or doctor’s care.
How would you rate mental health right now (excellent, good, okay, poor)? *
If Okay or Poor, please explain any current related challenges and any conditions requiring medication and/or doctor’s care.
How would you rate your overall life stability right now? *
If Okay or Poor, please explain.
Have you recently gone through a dramatic life change, loss of loved one, career change, etc? If yes, please explain. *
Voluntary Participation 1. I acknowledge that I have voluntarily applied to participate in a program or retreat ("this event") at Center for Spiritual Enlightenment ("CSE") at 1146 University Ave, San Jose, California. Assumption of Risk 2. I am aware that participating in this event may involve strenuous physical activities such as physical work, meditation, yoga, or movement classes, as well as risks associated with living in an city environment. I am also aware that this is an intensive retreat and that participants in such retreats may experience altered states of consciousness arising from the meditation and associated retreat activities. I am voluntarily participating in these activities with full knowledge of the risks involved, and hereby agree to accept any and all risks of harm that may result from these activities. Release 3. As consideration for being permitted by CSE or one of its affiliates to participate in these activities and use their facilities, I hereby agree that I, my assignees, heirs, distributees, guardians, and legal representatives will not make a claim against, sue or attack the property of CSE, its affiliates, employees, agents or volunteers or any of its affiliated organizations for injury or damage resulting from acts, howsoever caused, by any employee, agent, or contractor of CSE, or any of its affiliated organizations, as a result of my participation in this event, except when an employee, agent, or contractor of CSE or any of its affiliated organizations exhibits gross negligence or intentionally acts in a manner likely to lead to my being harmed. I hereby release CSE and any of its affiliated organizations from all actions, claims or demands that I, my assigns, heirs, distributees, guardians, and legal representatives now have or may hereafter have for injury or damage resulting from my participation in this event, except when an employee, agent, or contractor of CSE  or any of its affiliated organizations exhibits gross negligence or intentionally acts in a manner likely to lead to my being harmed. Knowing and Voluntary Execution 4. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between myself and CSE and/or its affiliated organizations, and sign it of my own free will. By clicking the check box below I acknowledge that I agree to the above terms and conditions.
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