Retreat Registration - One Day YMJJ - Providence Zen Center

Consent*

I understand that there may be people without a Covid-19 vaccination on the Providence Zen Center property.

Unvaccinated people will NOT be attending the retreat

Vaccination Proof*

All Kyol Che retreatants are required to show proof of vaccination.

Please have your vaccination card with you upon arrival or send a copy to director@providencezen.org

Proof of Negative Test Result*

All Kyol Che Retreatants are required to show proof of a negative PCR test result within a week of their entrance date.

Please have your proof of a negative PCR test result with you upon arrival or send a copy to director@providencezen.org

Name*

First Last

Phone*

Email*

Gender*

We'll assign shared rooms by the same gender.

What is your age-range?*

Again, this information will help us with room assignments.

What precepts have you taken?*

Please indicate your previous retreat experience, if any:*

Kwan Um School of Zen is abbreviated: KUSZ

Are you currently a dues paying member of the Kwan Um School of Zen?*

Have you sat any 1- or 2-day retreats in the Kwan Um School of Zen?*

When will you be entering the retreat?*

When will you be exiting the retreat?*

Are you a full-time student, senior citizen (over 65) or clergy member?*

Do you have any medical or dietary issues?

Anything else you wish us to know?

Are you currently a member?*

Total

$0.00

Payment Method*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

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