Which date(s) are you registering for?
July 24August 21
Are you joining us online or in-person?
Your Full Name (required)
Your Email (required)
Your Cell or Telephone Number
Your address (include city and state)
Emergency Contact Name (required)
Emergency Contact Phone (required)
How did you hear about this retreat?
You must complete this portion of the retreat application even if you have informed us of medical issues before please include the information again. We request the following information to help us determine whether or not participation in a retreat will aggravate a serious medical condition, endanger a participant's health, or disrupt the functioning of a retreat. The information provided will be kept strictly confidential to protect the applicant's privacy.
-Serious back or leg ailments
-Dizziness, palpitation, or shortness of breath due to meditation
-High or low blood pressure
-Major surgery or infections disease
-If you have been treated for serious emotional or psychological symptoms
Please briefly state the nature of each problem and the current condition. If you have no medical conditions please type None. (required)
By clicking "Send Application", I testify that all the information I have provided Tallahassee Chan Center is correct and complete. I understand that if I withhold any necessary information, I may be excluded from future participation. If I am accepted, I agree to finish the entire event. I understand that if I leave the event without permission, my application to future events may not be accepted. You will need to sign a liability waiver prior to attending the retreat.