Your Centered Self Retreat Registration
A few questions to help us get to know you.
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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.
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