Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Spring Retreat 2025 Registration
Sign in to Google
to save your progress.
Learn more
Name
Your answer
Phone Number (Cell)
Your answer
Email Address
Your answer
Attendance
Which days will you attend?
March 22 - Full Day
March 22 - Half-Day 8:30 to 1:00
March 22 - Half Day 1:30 to 5:00
March 23 - Full Day
March 23 - Half Day 8:30 to 1:00
March 23 - Half Day 1:30 to 5:00
Other
The only meal we will share is lunch (bring your own). The tea breaks will include nutritious snacks.
Your answer
Do you have any food sensitivities we should know about?
Your answer
Emergency contact with phone and email
Your answer
Cost: $40 / day; $25 / half-day
Your answer
Method of payment:
E-Transfer. Send to
andrew@safermindfulness.com
(no security code needed)
Cash or Cheque: Drop off at 58 Pennywell Rd.
Clear selection
Thank you!
The information on this form will be kept confidential by Safer Mindfulness, and will not be shared with a third party.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report
