[Imported Form] Women's Retreat Form 2022

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To submit your registration for the Women's Glamping on April 22, 2025, to April 24, 2025, please complete the following information and click submit.

Para enviar su registro para el Glampamento de Mujeres el dia 22 de Abril 2025 a Abril 24, 2025, complete la siguiente información y haga clic en NEXT.

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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.

4

Emergency contact / Contacto de Emergencia* This field is required.

First Name

Last Name

5

Street Address / Direccion* This field is required.

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City /Ciudad* This field is required.

7

State / Estado* This field is required.

8

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.N

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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 photosensitivity? / Tiene alguna fotosensibilidad?* This field is required.

Yes / Si

No

14

Are you comfortable self-administering any of your daily medications? / Se siente cómoda autoadministrándose sus medicamentos diarios?* This field is required.

Yes / Si

No

15

Are you comfortable sharing a room during the retreat? Se sientes cómodo compartiendo habitación durante el retiro?* 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 all medications and dosages you take (include emergency medications) / Incluya todos los medicamentos y dosis que toma (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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Please indicate which activities you would like to sign up for /Indique a qué actividades le gustaría inscribirse

Archery / Tiro de Arco

Fishing / Pescar

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Please verify that you are human* This field is required.