Sesshin Application

Sesshin Date(Required)

Please choose a sesshin

Name(Required)

First Last

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Is this is a new address?

Yes

Email Address(Required)

Cell Phone

Work Phone

Home Phone

Date of Birth (mm/dd/yyyy)

Will you attend via Zoom or in person?(Required)

In person

On Zoom

Have you attended a sesshin before(Required)

Yes

If yes, please list the most recent and longest sesshins you’ve attended:

Month/Year

Location

Conducted by

Number of Days

Are you attending the entire sesshin?(Required)

Yes

If not, briefly tell us which days and times you would like to attend:

Current Membership Status(Required)

Member

Non-member

Length of Membership (years)

Please enter a number greater than or equal to 0.

If, in a formal ceremony, you have become the student of a Zen teacher, please enter the teacher’s name:

Online Sesshin

Have you attended a Zoom sesshin with us before?

Yes

For those who haven't attended an online sesshin with us, there is an orientation session shortly after the sesshin begins.

Online Sesshin Fee

For online sesshin, our rate is $7/block for both members and non-members. We ask that those who wish to be eligible for dokusan attend at least two of the four blocks:

Block 1: 4:45am - 7:00am
Block 2: 9:30am - 12:30pm
Block 3: 1:30pm - 5:15pm
Block 4: 7:00pm - 9:30pm

Optional Training Fund Contribution

Please enter a number greater than or equal to 0.00.

For members unable to afford the sesshin, our teachers have a training fund they can use to provide assistance. If you would like to donate to this fund and help others to attend sesshin, please indicate the amount in the field above.

In-Person Sesshin

Please note: The morning after four- and seven-day sesshins, there is a final, festive breakfast at 10:00 a.m. in Rochester, so plan to stay for that if you can.

Have you attended a sesshin at Chapin Mill before?

Yes

Please note: If you have never attended sesshin in-person at Chapin Mill, there is an orientation session two hours before sesshin begins.

I need to sit in a chair:

Never

Part-Time

Full-Time

Dietary restrictions

List any dietary restrictions or food allergies that might affect your sesshin and give some indication of their seriousness. NOTE: if you have a serious food allergy, please also contact the Head Cook directly.

Describe any other allergies (including allergies to drugs):

Do you prefer a shower or a soaking bath?

Shower

Soaking bath

The Chapin Mill Retreat Center has two communal hot tubs that require a shower before soaking. If you would prefer to only take a shower, please click the "Shower" option.

Will this be your first time using a Chapin Mill soaking bath?(Required)

Yes

Chapin Mill Soaking Bath Guidelines. Anyone who wishes to use a soaking bath is required to read and sign off on these guidelines:

There are two soaking baths; each includes a changing room, shower, hot tub, and cold plunge. During sesshin two people may be assigned to use a bath together during a 20-minute time slot. The first person showers and rinses off thoroughly before getting into the bath, and the second person follows. After soaking in the hot tub, you may also use the cold plunge. If others are scheduled to use the bath immediately after your time slot, it’s okay if you’re still finishing up in the changing room, but the bath and shower should be free.
The temperature of the hot tubs is approximately 105-108 degrees Fahrenheit (40.5 - 42.2 Celsius). If you have any health conditions that might be aggravated by using the bath, check with your physician before signing this form. We DO NOT recommend using it if you may be pregnant, or if you have a history of high blood pressure, heart disease, diabetes, or fainting. DO NOT use the hot tub if you have a history of seizures or any other condition that may cause loss of consciousness.
Signs of imminent fainting may include sweating; tingling of the lips, fingers or toes; light-headedness; and/or nausea. Should you experience any of these, get out of the tub immediately, but safely. If possible, get into a kneeling position on the floor with your head down, resting on the floor, or sit with your head resting between your knees.
Regardless of any health conditions, limit your time immersed in the hot tub to a MAXIMUM of 5 MINUTES.

In submitting my request for a soaking bath:(Required)

I’ve read the statement above and agree

Rides and rooms for out-of-towners

If applicable, please provide your sesshin travel information by answering these questions.

Before sesshin: (1) What is the arrival date and time of your bus, train, or airline with flight number? (2) Will you need a ride when you arrive? (3) Will you need a room at AP or CM?
After sesshin: (4) Will you need a room at AP or CM? (5) Will you need a ride when you depart? (6) What is the departure date and time of your bus, train, or airline with flight number?

Emergency Contact(Required)

Please enter the name and contact information for anyone you would like us to get in touch with in the event of an emergency.

In-Person Sesshin Fee

Our in-person rate is $85/day for members. For non-members, it’s $125/day. For those coming part-time, the charge is $25/block for members and $35/block for non-members.

For help covering costs, consider requesting Training Fund assistance. (The link opens in a new tab).

Block 1: 4:45am - 7:00am
Block 2: 9:30am - 12:30pm
Block 3: 1:30pm - 5:15pm
Block 4: 7:00pm - 9:30pm

Optional Training Fund Contribution

Please enter a number greater than or equal to 0.00.

Medical Information

Please answer the questions below in detail, even if you’ve done so for a previous sesshin.

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).

Medical Conditions and Medications (if any)

Please list anything you would like the teacher and monitors to be aware of.

Please list any hospitalizations or major surgeries you have had in the past five years:

Describe any significant problems with your back or legs:

If you have experienced dizziness, fainting, palpitations or shortness of breath during sitting, please describe the nature of the problem:

Please complete the following two questions if this is your first sesshin with the Rochester Zen Center or if the information has changed since you last answered these questions:

Please give details of any serious psychological problems or crises, whether or not you were treated or hospitalized:

Have you ever attempted to take your own life?

Yes

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

Sesshin Consent

In submitting this application, I agree as follows:

I will finish the entire sesshin or that portion I’ve applied for.
WAIVER OF LIABILITY: I understand that sesshin is a period of strenuous traditional Zen training involving some 10 hours of formal meditation per day. In accordance with this understanding and in consideration for the Center’s accepting me to sesshin, I agree that neither the Rochester Zen Center nor any of its employees, officers, trustees, or trainees - nor any person acting as sesshin monitor or otherwise supervising, overseeing, or conducting any aspect of sesshin - shall be liable to me or to any other person for any loss or injury suffered by me in connection with my participation in sesshin, whether or not such loss or injury is caused by any act or omission of the Center or any of the persons specified above.

Consent(Required)

I’ve read the statement above and agree

PLEASE NOTE: this form may take several seconds to submit.

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Administrative Notes

Name

This field is for validation purposes and should be left unchanged.