Retreat Application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Are you attending the whole retreat? *

Yes No

Email *

Phone Number *

Emergency Contact Name and Phone Number: *

If not, please tell us which days and times you would like to attend: *

Have you ever attended a meditation retreat? *

Yes No

If yes, please list the most recent and longest retreats you have attended: *

A retreat can be a physically and psychologically demanding experience. We encourage participation in every activity, though no activities are required. If you have physical limitations that may affect your participation in retreat activities, please list them here; or, if confidential, please let us know here which teacher you would like to speak with before the retreat. If you are concerned about the psychological demands of a retreat, please let us know here which teacher you would like to speak with before the retreat. *

WAIVER OF LIABILITY: I understand that retreat is a period of strenuous traditional Zen training involving some 10 hours of formal meditation per day. In accordance with this understanding and in consideration for the Open Source’s accepting me to this retreat, I agree that neither the Open Source nor any of its employees, officers, trustees, or trainees - nor any person acting as sesshin monitor or otherwise supervising, overseeing, or conducting any aspect of retreat - shall be liable to me or to any other person for any loss or injury suffered by me in connection with my participation in this retreat, whether or not such loss or injury is caused by any act or omission of the Open Source or any of the persons specified above. I've read the statement above and agree: *

Yes No

Submit

Retreat application

Retreat Application