Thank You for Registering!

At an intensive our goal is to provide a place and a space where you can experience safety, healing, and transformation.

This confidential questionnaire will allow our team to pray and prepare for you to join us at the intensive retreat.

Name(Required)

First Last

Email(Required)

Phone(Required)

Do you have any food allergies?(Required)

No

Yes

What are your food allergies? (Enter N/A if none)(Required)

Emergency Contact During Intensive(Required)

First Last

Emergency Contact Phone(Required)

Emergency Contact Email

Do you have any hearing, visual, or physical impairments?(Required)

Yes

No

Is climbing a flight of stairs problematic for you? (Some accomodations are on the second level.)(Required)

Yes

No

What would you hope to gain by attending this weekend intensive?

List 3 things you would like us to know about you.

Are you comfortable in a spiritual setting?

Do you have any diagnosed medical or psychiatric conditions?

Are you currently seeing a counselor or psychiatrist?

Yes

No

If yes to last question, please list name and contact information.

Note any additional questions you have or fears you would like us to address prior to your Intensive.