Pa Women of Worth Retreat Registration Form

Connection & Relaxation Retreat

Sept 30-Oct 1, 2023
Full Name*

First NameLast Name
My Pronouns are
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Text Message Option*

Yes, I want to receive occasional text messagesNo, I prefer not to receive occasional text messages
E-mail*
I have:*

No horse experienceSome horse experience lessons, competition, never owned my own horse)Own or owned my own horseOther
I will be arriving:*

Friday afternoonOther
Something I want you to know about me is:
Remember to bring:
1. Dress for the weather
2. Closed toed shoes or boots
3. A journal and any other self-care items
4. A curious, open-mind
At Frog Pond Farm:

Meeting areas are inside with seating in climate control or outside with seating as weather allows.

Restrooms are available.

Cell service is limited. There is WiFi available, however we recommend staying present as much as possible, limiting phone usage.

Retreat details:

We will be meeting 4-5 times as a group, have some one-on-one sessions, and spending time alone in some activities.

We will be partnering with equines ranging from miniature horses to ponies to horses, all gentle and used to being around humans. They are still animals!

We will be providing light breakfast and lunches, one dinner on site. Please see enclosed list of dining and lodging options as you make your plans to attend.
If you have any dietary restrictions, please list them below.
If registering for more than one person, please provide their name, address, phone number, and email address
EX: Jane Doe, 123 Retreat Road, Laketown, PA 16111, janedoe@retreat.com
Registration Options
prevnext( X )
Connection and Relaxation Retreat (1 person)$450.00

Registering for:

Connection and Relaxation Retreat (2 person) $800.00

Registering for:

Total $0.00
Signature

Powered by Jotform SignClear
Organizer:

Leslie Cashion

502-684-2183

HerdRetreat@gmail.com

Retreat Coordinator:

Bethany Brown

317-385-1058

Website: www.CashionCreativeCounseling

Facebook: Holistic Equine Relationship Development-HERD
Should be Empty:

Connection & Relaxation Retreat