Zentensive December 2015
Date of Birth
Please include appropriate background information pertaining to any past experience with meditation – previous teachers, practices, or retreats; and also, any related information to your background with psychotherapy – personally or professionally.
Please include any other information you feel it would be helpful, or necessary, for us to know.
All medical information will be kept strictly confidential.
Please answer the following questions in detail. The purpose of requesting this information is to help determine whether attendance at sesshin might adversely affect an applicant’s health and/or the well-being of others. It also helps those conducting sesshin to be aware of physical and mental conditions that may require special consideration. For this reason it is vital that all health information be current and specific in regard to both active and inactive conditions. This medical information is solely for the reference of teachers and monitors and will be kept confidential.
If you would prefer to speak privately with a teacher, this can also be arranged.
1. List any medications you are currently taking and the reasons for their use.
2. List any major surgeries you have had in the past 5 years.
3. Will you need a chair?
Do you have any food allergies?
Do you snore?
6. Have you ever been institutionalized or incarcerated?
If yes, please provide details:
7. Describe any significant conditions that may affect you or others in Zentensive. This would include such things as allergies to foods or medications, current illnesses, snoring, menstrual difficulties, being pregnant, etc.
8. For people Lawson doesn’t know, please list any relevant meditation experience you’ve had, and any such retreats you’ve attended.
9. Have you ever been in psychotherapy?
10. Are you in psychotherapy at this time?
In order to provide a strong, safe and stable environment for you and everyone else at sesshin, please also respond to the following questions:
11. Have you ever seriously contemplated or attempted to take your own life?
12. Is there anything else related to your past or current life circumstances that would be helpful for us to know about and that might have some bearing on Zentensive?
If you have answered Yes to either of these last questions, please provide details below, and/or set up a time to talk with a teacher directly.
Please also notify us of any medical conditions that may arise after you have submitted this application.
Payments via Check or Money Order
Checks or money orders can be made payable to:
Windhorse Zen Community (or simply WZC)
And sent to:
580 Panther Branch Road
Alexander, NC 28701
*Please use the Paypal payment option below this form after submitting registration.
By submitting this application, I agree as follows:
I will uphold the spirit of the sesshin guidelines.
I will finish the entire sesshin or portion of sesshin for which I have applied.
Waiver of Liability: I understand that a Zentensive includes periods of intense training. In accordance with this understanding, and in consideration for my being accepted, I agree that neither Windhorse Zen Community nor any of its officers or trustees – nor any person acting as a monitor, or overseeing any aspect of the retreat – shall be liable for any loss or injury suffered by me in connection with my participation.