Rachel's Vineyard Retreat
December 3-5, 2021 Tallahassee, FL (Specific Location site is confidential, please email for more details)
Cell Phone #
Street Address Line 2
State / Province
Postal / Zip Code
Is it ok for us to contact you via email and send you emails?
Date Of Birth
Are you on any medications?
How many abortions have you had?
How long since your last abortion?
How many miscarriages have you had?
How long since your last miscarriage?
Do you have a history of sexual abuse?
Are you comfortable in a spiritual setting?
What do you hope to gain by attending this Retreat?
List 3 things that you would like the team to know about you.
Emergency Contact Name
Emergency Contact Phone Number
The total cost of the Retreat is $100. A deposit of $50 is required to reserve your place. Please mail deposit to: Rachel's Vineyard Ministry @ Good Shepherd Catholic Church, 4665 Thomasville Road, Tallahassee, FL 32309
By typing your name above you are committing to May 15-17, 2020 Rachel's Vineyard Retreat. Deposits are non-refundable.
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