September 25 -28, 2025

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Please click below if this is a new Phone Email Address

Please List any Allergies

Emergency Contact Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Relationship to Retreatant REQUIRED Please fill out this field. Please enter valid data.

Room Preference REQUIRED 1st Floor 2nd Floor No Preference Please fill out this field.

Suite mate preference (if known) Please enter valid data.

Room # preferred (if known) Please enter valid data.

Religious Affiliation Catholic Baptist Presbyterian Methodist Episcopalian Lutheran Protestant Jewish Other

Age Demographics 21 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 80 - 89 90+

Name of Church Parish Please enter valid data.

Retreat Payment:

A non-refundable $150.00 deposit is required to secure your registration and will be applied towards your final payment. the full payment includes the deposit amount. If you pay the deposit only, your balance will be due upon check-in for your retreat. Please enter valid data.

Retreat Payment: REQUIRED

150.0 – Deposit only (Non-refundable)

400.0 – Payment in Full Please fill out this field.

Donation Opportunities:

All donations received above the full cost of your retreat are considered tax deductible. Donations that go towards our Maintenance Fund specifically help us with the upkeep and maintenance of our building and grounds. General retreat donations above the cost of your retreat often help to provide the opportunity for those who otherwise would not be able to attend a retreat due to financial difficulties the chance to attend a retreat. Thank you for supporting our ministry and for your generosity!

Maintenance Donations $ Please enter a positive decimal.

Retreat Donations $ Please enter a positive decimal.