Tea Ceremony

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* These fields are required

1 Welcome

2 Housing & Program Fees

3 People in your group

4 Participant Info

ZCLA has my personal and emergency contact information on file. *	Yes No Unsure/Wish to Update
Gender
Address
Address 2
City
State/Prov.
Zip/Postal
Country
Emergency Contact Info	Please list at least one contact with phone numbers where they can be reached during the retreat.
Medical Issues	Please describe any physical, psychological, medical, dietary, allergy-related, accessibility, or other conditions that may affect your participation in sesshin, including any symptoms you have experienced while meditating (such as headaches, dizziness, heart palpitations, or shortness of breath). If none, please write "None."
Comments or Special Needs
Email newsletter	Please send me the email newsletter
Terms and Conditions	I accept the terms and conditions.I agree to maintain a daily sitting practice from the time of this application through the sesshin. I will participate to the extent I have specified above. I understand that my physical, mental, and emotional well-being are my own responsibility and understand that practice is not a substitute for therapy. I am receiving treatment for any medical or psychological condition(s) that I have, and I have revealed all pertinent information on this form. I am capable of undertaking the rigors of sesshin at this time. I agree that neither the Zen Center of Los Angeles 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 sesshin - shall be liable to me or to any other person for any loss or injury suffered by me in connection with my participation in sesshin, whether or not such loss or injury is caused by any act or omission of the Center or any of the persons specified above

5 Part-Time Participants

Select the days and blocks that best reflect your intended participation. You may choose multiple blocks.
FULL-TIME PARTICIPANTS SKIP THIS SECTION.

Which days do you plan to participate?	Sunday Monday Tuesday Wednesday Thursday Friday Saturday Please select all days you anticipate participating. Your selections help us understand your intended schedule and plan accordingly.
Sunday	Full-Time Part-Time
Participation	Dawn (5:30-7:30 a.m.) Breakfast (7:40 a.m.) Samu (9:00 a.m.) Morning (10:55 a.m.-12:15 p.m.) Lunch (12:30 p.m.) Yoga (2:30 p.m.) Afternoon (3:30-5:25 p.m.) Medicine Meal (5:40 p.m.) Evening (7:25-9:00 p.m.)
Monday	Full-Time Part-Time
Participation	Dawn (5:30-7:30 a.m.) Breakfast (7:40 a.m.) Morning (10:55 a.m.-12:15 p.m.) Lunch (12:30 p.m.) Yoga (2:30 p.m.) Afternoon (3:30-5:25 p.m.) Medicine Meal (5:40 p.m.) Evening (7:25-9:00 p.m.)
Tuesday	Full-Time Part-Time
Participation	Dawn (5:30-7:30 a.m.) Breakfast (7:40 a.m.) Samu (9:00 a.m.) Morning (10:55 a.m.-12:15 p.m.) Lunch (12:30 p.m.) Yoga (2:30 p.m.) Afternoon (3:30-5:25 p.m.) Medicine Meal (5:40 p.m.) Evening (7:25-9:00 p.m.)
Wednesday	Full-Time Part-Time
Participation	Dawn (5:30-7:30 a.m.) Breakfast (7:40 a.m.) Samu (9:00 a.m.) Morning (10:55 a.m.-12:15 p.m.) Lunch (12:30 p.m.) Yoga (2:30 p.m.) Afternoon (3:30-5:25 p.m.) Medicine Meal (5:40 p.m.) Evening (7:25-9:00 p.m.)
Thursday	Full-Time Part-Time
Participation	Dawn (5:30-7:30 a.m.) Breakfast (7:40 a.m.) Samu (9:00 a.m.) Morning (10:55 a.m.-12:15 p.m.) Lunch (12:30 p.m.) Yoga (2:30 p.m.) Afternoon (3:30-5:25 p.m.) Medicine Meal (5:40 p.m.) Evening (7:25-9:00 p.m.)
Friday	Full-Time Part-Time
Participation	Dawn (5:30-7:30 a.m.) Breakfast (7:40 a.m.) Samu (9:00 a.m.) Morning (10:55 a.m.-12:15 p.m.) Lunch (12:30 p.m.) Yoga (2:30 p.m.) Afternoon (3:30-5:25 p.m.) Medicine Meal (5:40 p.m.) Evening (7:25-9:00 p.m.)
Saturday	Full-Time Part-Time
Participation	Dawn (5:30-7:30 a.m.) Breakfast (7:40 a.m.) Samu (9:00 a.m.) Morning (10:55 a.m.-12:15 p.m.) Lunch (12:30 p.m.) Yoga (2:30 p.m.) Afternoon (3:30-5:25 p.m.) Medicine Meal (5:40 p.m.) Evening (7:25-9:00 p.m.)

6 Meal Count

7 Request Dharma Training Fund

8 Donate

9 Security Check

10 Payment