Your Centered Self Retreat Registration
A few questions to help us get to know you.
Email address *
The lake at Sunrise Ranch
What is your name? *
Your answer
Do you have experience attending retreats? *
Please describe your experiences briefly, positive or negative
Your answer
Are you currently or have in the past been in personal therapy? *
Please describe your experiences briefly, both positive and negative
Your answer
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.
Your answer
What are your hopes for this experience? *
Your answer
What are your concerns or hesitations about this experience? *
Your answer
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) *
Your answer
Are you currently taking any medications, and or do you have any medical conditions or considerations we should be aware of? *
Your answer
Your contact info: (Name, Date of Birth, address, phone and email.) *
Your answer
Emergency contact info: (Name, relationship, phone number) *
Your answer
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!
Your answer
A copy of your responses will be emailed to the address you provided.
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