Sesshin Application

If you wish to attend the coming sesshin and retreats please complete the following form:

Name:*
E-mail:*
Phone:
-
Address:
Gender:*
Date of Birth (mm/dd/yyyy):*
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.

Sept. 5 - 12, Osesshin led by Harada Roshi.

Partial attendance is available for Kosesshin,  please mark dates. If attending entire kosesshin or first days, please attend Kokuho (on zafu by 7:30pm) 

Kosesshin lead by Harada Roshi
Kosesshin lead by Daichi Roshi [24th. may be cancelled]

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, please indicate where:
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:
 / 
 / 
Priest ordination with:
Priest Ordination Date
 / 
 / 
Optional comments regarding Practice
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 fees are $350. Kosesshin fee is $50 per day.

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