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Rochester Zen Center

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Home > Sesshin > Chapin Mill Work Retreat Form

Chapin Mill Work Retreat Form

Chapin Mill Work Retreat Form

  • MM slash DD slash YYYY
  • Chapin Mill Work Retreat Donations

    There’s no fee for the work retreat (although donations for food are welcome). If you would like to donate, after submitting this application you'll have an opportunity to make a tax deductible contribution to the Center via the PayPal Giving Fund.
  • Personal Information

  • MM slash DD slash YYYY
  • Please enter the name and contact information for anyone you would like us to get in touch with in the event of an emergency.
  • Work Skills

  • Medical Information

    Please answer the questions below in detail, even if you’ve done so previously.

    Please list any medical conditions you have that require regular care or medication (include pregnancy, current infections, high or low blood pressure, communicable diseases or chronic headaches).
  • Please list anything you would like us to be aware of.
  • List any dietary restrictions or food allergies that might affect your time with us and give some indication of their seriousness. NOTE: if you have a serious food allergy, please also contact the Head Cook directly.
    The Chapin Mill Retreat Center has two communal soaking baths. If you would like to take a bath rather than a shower, check that box, and if we can schedule you for one, we will.
  • If coming from out of town, will you need a ride from the airport, and would you like a room at Arnold Park or Chapin Mill before or after the work retreat?
  • Please complete the following two questions if this is your first time visiting the Rochester Zen Center or if the information has changed since you last answered these questions:

  • PLEASE NOTIFY THE HEAD OF ZENDO OF ANY MEDICAL OR OTHER CONDITIONS THAT ARISE AFTER SUBMITTING THIS APPLICATION

  • In submitting this application, I agree as follows:
    • WAIVER, ASSUMPTION OF RISK AND RELEASE: In consideration for my being permitted by Rochester Zen Center (RZC) to participate in its Chapin Mill Work Retreat, I understand that RZC will provide to all Work Retreat participants full training in all operations which they are asked and agree to perform, including full safety instructions, and I will not perform any operation during the Work Retreat without having received all such relevant instructions. I will adhere to those instructions throughout the Work Retreat. I hereby assume all risk in connection with my participation in the Work Retreat. I hereby waive and release all claims against RZC and its officers, trustees, and representatives (the “Releasees”) with respect to their negligence and intentional wrongdoing in connection with the planning for and administration of the Work Retreat, and I agree not to pursue any claim or action against any of the Releasees with respect to the Work Retreat in litigation, arbitration or any other proceeding. I understand and acknowledge that RZC will permit me to participate in the Work Retreat in reliance upon my representations and agreement as set forth above.
  • This field is for validation purposes and should be left unchanged.

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  • Get Started
    • What is Zen Practice?
    • How to Sit
    • Intro to Zen: Meditation Workshop
    • Tuesday Beginners’ Night
  • Practice with us
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    • Weekly Schedule
    • Extended Sitting
    • Residential Zen Training
    • Live Streaming Audio
  • Community
    • Family Program
    • Uprooting Racism
    • Zen of Living and Dying
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7 Arnold Park, Rochester, NY 14607 (585) 473-9180

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