Sesshin Application

If you wish to attend the coming sesshin (May. 5 -12, and May 14-21 2019),
please complete the following form:

Name:*
E-mail:*
Phone:
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Address:
Gender:*
Birth date:*
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Schedule

Sesshin start the evening of the first date (5pm.) and end the evening of the last date (9:30pm).
You are welcome to arrive in the days before sesshin and stay after sesshin.
Significant work is needed to setup for sesshin and clean-up afterward. Please expect to make a contribution to this work.

Osesshin led by Harada Roshi. Kokuho the night of the 5th., continuing to the night of the 12th.
Osesshin with Daichi Zenni Kokuho is the night of the 14th., Sesshin continues thru the 21st. Partial attendance is available.

Do you need to sit in a chair in the Zendo:
Do you need financial aid to attend: [Plan to arrive a day or more early or leave a day or more afterward]
Housing option:
If Housing is Off-Site, provide address and phone:
Practice Background
If you have experience at any of these temple roles and are willing to do, please check:
One Drop Zen Affiliation
Dharma name
Jukai Preceptor:
Jukai (Taking Precepts) Date:
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Priest ordination with:
Priest Ordination Date
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First time applicants please provide a brief practice history
Medical Information
Who to contact in Emergency:*
Emergency Phone:*
-
Emergency E-mail:*
Relationship to you:*
What prescription medications do you take? Do you have serious food allergies? (Please state) Do you carry an EpiPen? Other medical issues/need? Please let us know below
Medical Training; if you have, please let us know - RN, EMT, MD?

Osesshin fee is $400, or $60 per day.

Use PayPal now for Sesshin Fee?:
Sesshin Fee or Deposit -> Goes to PayPal and Submits Application
 $ 
Click "Submit"