Name:_____________________________________________________________Age:________Gender:________ |
Address:_____________________________________________________________________________________ |
City:__________________________________________________ State_________________ Zip______________ |
Home Ph:_______________________________ Work
Ph:_________________________________ |
Email___________________________________________________________________________ |
Emer. Contact (Name &
Phone)_______________________________________________________ |
Please register at least one prior to the beginning of sesshin
Those registering after one week prior
to sesshin should include the late registration fee (see below).
|
The next
sesshin is May 24 through 28, 2023
(Wednesday Evening to Sunday Evening) |
|
Part-time
attendance days & times:_____________________________________________________________________
_______________________________________________________________________________________________ |
Full COVID vaccination is required for attendance at PZC.
Masks are optional.
Suggested donation for attendance at PZC is $40 per day ($30/day
without meals). Zoom attendance is $25 per day. A reduced
donation amount is available for those on limited income. The registration
form with payment must be submitted by one week prior to
sesshin. Late registration requires an added $10 per day of
attendance.
A full refund is available for cancellation up to one week
before sesshin, 50% refund up to first day of sesshin. Newcomer's orientation is at 6:00 p.m.. Sesshin begins at 7:30 p.m.
Please idicate sesshin attending in check memo.
|
If you do not
have your own oryoki (eating bowls) and need to rent them,
check here ____ and add $5 to you sesshin
fee. |
WORK SKILLS (Select
what you have experience in, not what you want to do):
Cooking___ Electrical___ Carpentry___ Gardening___ Word Processing___ Flower Arranging___ |
Physical and other conditions
limiting participation (use back side of form, if necessary):
________________________________________________________________________________________________ |
Serious
Alergies:___________________________________________________________________________________ |
"I agree to maintain a daily sitting
practice between the time of application and sesshin and to
participate fully in the entire sesshin schedule. I understand
that my physical, mental, and emotional well-being are my own
responsibility. I understand that Zen practice is not a
substitute for therapy. I am seeking medical care or therapy for
existing conditions. I have notified doctors or therapists of my
participation and have ascertained their availability for
consultation, if necessary. I am capable of undertaking the
rigors of sesshin at this time. I have revealed all pertinent
information on this form. I also agree to sign a waiver
releasing the Center, its directors, volunteers, and the owners
of 515 S. Prospect from any liability resulting from my
participation in sesshin."
|
Signiture:____________________________ Printed
Name________________________________ Date:_____________ |
Send form and
payment to: Prairie Zen Center - 515 S. Prospect -
Champaign, IL 61820 |