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Marrow of Zen: Talks on Bodhidharma’s Two Entrances and Four Practices 2010
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Chanting

Retreat Application – April 29 to May 6, Jeff Shore

Are you registering for the online or in person retreat? (required)
OnlineIn Person

Did you receive a COVID Vaccination?
YesNo

Upload a picture of your vaccine card (.png, .jpg, or .pdf files accepted) (If you cannot upload at this time, please email it to tallahassee.chan@gmail.com)

What schedule do you plan to follow?
Extended Practice (3 Hours/Day)Deeper Practice (6 Hours/Day)Full Retreat (17 Hours/Day)

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?

Have you done retreats with Tallahassee Chan Center 2 days or longer before?
YesNo

If Yes to above, what month and year?

FIRST TIME APPLICANT INFORMATION

Occupation

Date of Birth

PRACTICE HISTORY

The purpose of collecting this information is for the retreat teacher to help guide your practice. Please include as much information as possible below:

Have you done a 7-day intensive meditation retreat before?
YesNo

Have you taken a meditation class before?
YesNo

What meditation method do you use?
Counting breathFollowing breathSamatha and VipassanaSilent IlluminationHua-tou
Other Method:
Have you studied meditation elsewhere?
YesNo

If yes to question above, where? and in what tradition?

If you have studied with another meditation teacher(s), who have you studied with?

Have you done retreat with that teacher(s)?
YesNo
How long have you studied with that teacher(s)?

How many years have you been practicing meditation?

Do you practice meditation regularly?
DailyWeeklyIrregularlyNever
Date of last retreat (3 days or longer, month & year only)

Why do you want to come on this retreat? Please also include any additional comments about your practice below

Do you plan to stay at the center housing?
YesNo

MEDICAL CONDITIONS

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.

Please include:
-Serious back or leg ailments
-Dizziness, palpitation, or shortness of breath due to meditation
-High or low blood pressure
-Heart Problems
-Major surgery or infections disease
-If you have been treated for serious emotional or psychological symptoms
-Dietary restrictions (for in-person retreatants)

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.

Tallahassee Chan Center is in solidarity with ending racism. Please view our statements here.