Green Gulch Farm Guest COVID-19 Safety Questionnaire and Release

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To help keep all participants of in-person SFZC events safe from COVID-19, we require that all teachers, students and guests be fully vaccinated, boosted, and submit proof of vaccination. All fields are required, except as noted.

Confirmation (Folio) Number if applicable (for overnight guests)

Enter 8-digit reservation confirmation number

When does your retreat start? (if applicable)

First Name

Last Name

Phone Number

Have you been vaccinated against Covid-19?

YesNo

Will you be getting your booster dose by the time you arrive? Please give details.

What vaccine(s) did you receive? How many doses of each one have you received and what was the date of your last dose?

Please upload a copy of your CDC/National COVID-19 vaccination card or California Digital COVID-19 Vaccine Record/SMART Health Card here.

If any of the following situations occur prior to visiting Green Gulch, you are required to contact the reservations office at reservations@sfzc.org or call 415-865-1899:

The onset of symptoms of COVID-19
Contact with anyone known to test positive with COVID-19 within 14 days of visiting Green Gulch

I understand and agree*

Once you have filled out this form, the reservations office will review your information and contact you if there are any issues. You will not be able to visit Green Gulch without completing this form.

I understand and agree

How would you like us to contact you?

EmailPhone

For updated information regarding Green Gulch Farm Covid Safety Protocols, please see here. If you have any questions about Covid protocols or waivers, or about your ability to visit Green Gulch please contact Reservations at reservations@sfzc.org or call 415-865-1899

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COVID RELEASE

I have voluntarily agreed to visit Green Gulch Farm (the “Facility”) which is a practice center within the San Francisco Zen Center (“Zen Center”).

I acknowledge the highly contagious nature of COVID-19. By signing this document, I voluntarily assume all risk of exposure, infection or other adverse consequences of COVID-19 arising out of my visit, including the period in transit to and from the Facility. I further acknowledge that the term “risk”, as used in this release, includes exposure or infection that may result in my personal injury, illness, disability, and/or death. I understand that the risk may be caused by the actions, omissions, or negligence of myself and others, including, but not limited to, Zen Center’s or the Facility’s directors, officers, employees, teachers, residents, agents, and representatives, contractors and volunteers and visitors, and further including family members of such persons. Accordingly, I understand and agree that this Release covers any claims based on the actions, omissions, or negligence of any and all persons listed in the preceding sentence, whether a COVID-19 infection may manifest itself.

I understand that this document is written to be as broad and inclusive as legally permitted by the State of California. I agree that should any portion be held invalid or unenforceable, I will continue to be bound by the remaining terms.

I AM AWARE THAT THERE IS A RISK OF BEING EXPOSED TO OR INFECTED BY COVID-19 WHILE IN TRANSIT TO/FROM GREEN GULCH FARM AND WHILE AT GREEN GULCH FARM

Acknowledged