Your Centered Self Retreat Registration
A few questions to help us get to know you.
Email *
The lake at Sunrise Ranch
What is your name? *
Do you have experience attending retreats? *
Please describe your experiences briefly, positive or negative
Are you currently or have in the past been in personal therapy? *
Please describe your experiences briefly, both positive and negative
Personal retreat can often bring up strong emotions. Do you feel able to care for yourself in a group setting if this happens for you? (Taking breaks when needed, asking for help or support, using internal resources) *
If needed, please use the space below to elaborate on the above question.
What are your hopes for this experience? *
What are your concerns or hesitations about this experience? *
How would it feel for you to spend a weekend disconnected from technology and devices? (Cell service is limited, in case of emergency, family can reach you through the front desk) *
Are you currently taking any medications, and or do you have any medical conditions or considerations we should be aware of? *
Your contact info: (Name, Date of Birth, address, phone and email.) *
Emergency contact info: (Name, relationship, phone number) *
Thank you for filling out the registration questionnaire! You will be contacted shortly by a retreat facilitator to complete the registration process including tuition payment. Please use the space below to share anything else you'd like us to know about you. We can't wait!
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy