Sesshin Application

Sesshin Date*
Please choose a sesshin
Will you attend via Zoom or in person? (Please note that we are requiring full vaccination for those who attend in person.)*
- In person
- On Zoom
For those attending in person, the morning after four- and seven-day sesshins, there is a final, festive breakfast at 9:00 a.m. in Rochester, so plan to stay for that if you can.
If you will attend in person, please enter the date of your full vaccination
MM slash DD slash YYYY
Are you attending the entire sesshin?*
- Yes
- No
If not, briefly tell us which days and times you would like to attend:
Sesshin Fee:
For IN-PERSON SESSHIN, our rate is $45/day for members. For non-members, it’s $65/day. For those coming part-time, the charge is $12/block for members and $17/block for non-members.

For ONLINE SESSHIN, our rate is $5/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
Training Fund:
For members unable to afford the sesshin, our teachers have a 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 here:
Please enter a number greater than or equal to 0.00.
Personal Information
Name*
First Last
Date of Birth (mm/dd/yyyy)
MM slash DD slash YYYY
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Is this is a new address:
- Yes
- No
Home Phone
Work Phone
Cell Phone
Email Address*
Emergency Contact
Please enter the name and contact information for anyone you would like us to get in touch with in the event of an emergency.
Membership Status
Current Status:*
- 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:
Sesshin Experience
Have you attended a sesshin before*
- Yes
- No
If yes, please list the most recent and longest sesshins you’ve attended:
Month/Year Location Conducted by Number of Days
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:
I need to sit in a chair:
- Never
- Part-Time
- Full-Time
If you have experienced dizziness, fainting, palpitations or shortness of breath during sitting, please describe the nature of the problem:
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):
Soaking bath or shower
- Shower
- Soaking bath
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.
Rides and rooms
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?
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
- No
PLEASE NOTIFY THE HEAD MONITOR OF ANY MEDICAL OR OTHER CONDITIONS THAT ARISE AFTER SUBMITTING THIS APPLICATION
If there are any pressing circumstances, such as difficulty arranging time off from work, that would prevent you from applying to another upcoming sesshin, please explain here.
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 during which participants may frequently be struck with the kyosaku (encouragement stick). 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.
*
- I’ve read the statement above and agree:
Hidden
Administrative Notes
Phone
This field is for validation purposes and should be left unchanged.

Month/Year	Location	Conducted by	Number of Days

Sesshin Application

Sesshin Fee:

Training Fund:

Personal Information

Membership Status

Sesshin Experience

Medical Information

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