Women's Retreat Form

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A peaceful women’s retreat held at a private ranch, designed to rest, recharge, and reconnect. Guests will enjoy meaningful activities, shared meals, and time in nature creating space for reflection, connection, and renewal in a serene, supportive setting. A female adult caregiver may accompany person with epilepsy and attend the Women’s Retreat. Transportation will be provided. Ages 27 and older.

To submit your registration for the Women's Retreat on Thursday, February 26th, - Sunday March 1st, 2026, please complete the following information and click submit.

Un retiro de mujeres en un rancho privado, diseñado para descansar, recargar energías y reconectar. Las participantes disfrutarán de actividades significativas, comidas compartidas y tiempo en la naturaleza, creando un espacio para la reflexión, la conexión y la renovación en un ambiente sereno y acogedor. Una cuidadora adulta puede acompañar a la persona con epilepsia y asistir al Retiro de Mujeres. Se proporcionará transporte. Edades de 27 años en adelante.

Para enviar su registro para el Retiro de Mujeres, del jueves 26 de febrero al domingo 1 de marzo de 2026, por favor complete la siguiente información y haga clic en Enviar.
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Name of Participant / Nombre de la Participante * This field is required.
First Name
Last Name
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Age of participant / Edad de la participante* This field is required.
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Street Address / Direccion* This field is required.
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City /Ciudad* This field is required.
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State / Estado* This field is required.
Texas
Please Select
Alabama
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Delaware
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Maine
Maryland
Massachusetts
Michigan
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New Hampshire
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South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
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Zip / Codigo Postal* This field is required.
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County/ Condado* This field is required.
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Phone Number / Numero de telefono* This field is required.
phone number
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Do you have any food allergies?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Email / Correo electronico* This field is required.
example@example.com
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Do you have epilepsy? / Tiene Epilepsia?* This field is required.
Yes / Si
No
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Do you have any food allergies?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
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Do you have any photosensitivity? / Tiene alguna fotosensibilidad?* This field is required.
Yes / Si
No
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Are you comfortable self-administering any of your daily medications? / Se siente cómoda autoadministrándose sus medicamentos diarios?* This field is required.
Yes / Si
No
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Are you comfortable using the group transportation vans? (Partipants using vans will need to report to San Antonio office) / Se siente cómodo utilizando las camionetas de transporte grupal? (Los participantes que utilicen camionetas deberán presentarse en la oficina de San Antonio)* This field is required.
Yes /Si
No, I prefer to drive myself / No, prefiero conducir yo mismo.
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Please include any emergency medications / Incluidos los medicamentos de emergencia):* This field is required.
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Will you need assistance taking medications or assistance with reminders at the retreat? / Necesitará ayuda para tomar medicamentos o ayuda con recordatorios en el retiro?* This field is required.
Yes medication administration help is needed. / Sí se necesita ayuda con la administración de medicamentos.
No help is needed. / No se requiere ayuda
Only reminders are needed. / Sólo se necesitan recordatorios
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Is the participant able to shower, use the restroom, walk, and feed themselves independently without assistance? / El participante puede ducharse, usar el baño, caminar y alimentarse de forma independiente sin asistencia* This field is required.If no, please explain
Please explain
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Emergency Contact/Contacto de Emergencia:* This field is required.
Name/Nombre
Contact Number/Numero de contacto
Email/correo electronico
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If traveling with caregiver / Si viaja con una persona cuidadora
Name/Nombre
Do you have any food allergies / Tiene alguna alergia a los alimentos
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PHOTO/VIDEO RELEASE* This field is required.
I give permission for photos or videos taken of me during the program to be used for promotional or educational purposes by EFCST.
I do not give permission for photos or videos of me to be used.
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Please verify that you are human* This field is required.
Should be Empty: