| Prairie Zen Center Sesshin Application |
| Name:______________________________________________________Age:______Gender:_____ |
|
Address:________________________________________________________________________ |
|
City:___________________________________________ State__________ Zip______________ |
| Home Ph:_______________________________ Work
Ph:_________________________________ |
|
Email___________________________________________________________________________ |
| Emer. Contact (Name &
Phone)_______________________________________________________ |
Circle the sesshin for which you are applying.
Rates are member / non-member.
Apply 2 weeks prior to sesshin. |
May 22nd to 27th
$175 / $250 |
July 12th to 14th -
Spfld
$105 / $150 |
Aug 28th to Sept 2nd
$175 / $250 |
|
| Part-time
attendance days & times:_____________________________________________________ |
|
The cost for
part-time attendance is $35 per day for dues paying members;
non-members pay $50 per day. For those on limited income, a
fee of $25 per day is available on request. The registration
form with payment must be submitted two weeks 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. Newcomer's orientation is at 6:00 p.m.; check in
no later then 7:00 p.m. Sesshin begins at 7:30 p.m.
|
| If you need to rent
oryoki (eating bowls) 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 |