Kwan Um School of Zen in Hungary
Address: Budapest Zen Center, Bajza u. 58. Phone: +36 30 408 1211 Fax: +36 1 408 1211
www.kvanumzen.hu www.wonkwangsa.net e-mail: kyolche AT gmail DOT com

 

Application Form for 2009 Winter Kyol Che – Won Kwang Sa Int’l Zen Temple

Personal and retreat data

Name: Gender:
Birth date:
Address:
Phone: E-mail:
Retreat Start Date:
Retreat Finish Date:
I would like a pickup from the bus/train station Yes - Where and when? No
I wish to take precepts at the end of the Kyol Che Yes - What precepts? No

Practice background and previous experience

I pay membership fee to Kwan Um School of Zen
National sangha I pay to:
Name of my zen center:
Guiding Teacher’s name:
I do not pay membership fee to Kwan Um School of Zen
Name of my Buddhist School, Order or Tradition:
My buddhist precepts: None 5 Precepts DTIT Dharma teacher Bodhisattva Teacher
Date of my precepts:
My Buddhist name:
YMJJs and Kyol Ches or other retreas you did (where and when):

Health and food

Do you have any health related issues including allergies or problems with digestion? Yes No
If yes, please describe:

Are you on any long term medication? Do you need ongoing medical attention/treatment? Yes No
If yes, please describe:

Emergency contact

Name: Relationship:
Phone: E-mail:

Waiver of liability

I the applicant as specified above understand that my participation in
any activity of the Kwan Um School of Zen (KUSZ) is voluntary and I agree that I will not
participate in any activity for which I have reason to believe I am ill-suited, physically or mentally
incapable, or which I believe would create for me an undue danger of physical/mental harm.

I agree to inform the KUSZ representatives of any existing medical conditions or previous mental disorders or
events that are relevant to my participation in the activities. In the event of any injury resulting
from my participation in any of these activities, I agree to bear all medical costs and I hereby waive
and release the KUSZ from any claim of liability against the KUSZ or its members and subsidiaries, and
indemnify the KUSZ against any loss suffered by it as a result of my injury.