Retreat Application

Choose a Retreat*
Desired Date*
Date Format: MM slash DD slash YYYY
Name*
Email*
Once confirmed for a retreat may I use this email in a group email?
- Yes
- No
Phone
How may I contact you? (please check all that apply)
- Email
- Phone
- Text
Address
Street Address City State / Province / Region ZIP / Postal Code
Date of Birth
Date Format: MM slash DD slash YYYY
Marital & Family Status (please check all that apply)
- Single
- Married
- Children
Wedding Date
Date Format: MM slash DD slash YYYY
Spouse's Name
How many children do you have?
Childrens' Names & Ages
Where do you stay busy during the week?
What type of work?
Do you attend church?
- Yes
- No
Where do you attend?
Please list any medical conditions or food allergies I need to know about
Why you have selected your retreat?
Describe your present relationship with the Lord
What strengths do you bring to being with other women in this time?
What limitations do you bring to being with other women in this time?
Note: You will never be denied because you’re not attending church, or your relationship with God is rough, or if being with women is hard for you etc. These things are common and understood. Be yourself here. This is the beginning of your safe place. I believe you will know if you have a medical condition that could disrupt your ability to participate in a retreat like this. I believe you will choose well.

Contact Midge

midge@mindofchristaz.com
Phone: 480-980-7759

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