Colorado Trail Life Training

Life-Giving Wounds Retreat Registration Form
Full Name

First NameLast Name
Email Address
example@example.com
Cell Phone Number
Format: (000) 000-0000.
Age
Street Address
City
State
Religious Affiliation
Specify if "Other"
If Catholic, your Diocese
Name of Catholic Parish or 'none'
Parents' Relationship Status
Your Relationship Status
Are any family members, significant others, or close friends attending this event with you? If yes, whom?
Others attending this event with you
Name of Emergency Contact
Phone # of Emergency Contact
Have you discussed your family wounds with a counselor, priest, or trusted friend? Yes, No , or Other
Do you feel emotionally and psychologically capable at this time to attend an event where strong emotional content about family life will be discussed, shared, and processed? (If you are seeing a psychologist, then please consult first with him or her about whether he or she believes it is a good idea for you to attend a peer group like this one.) Yes, No, or Other
Do you have any food allergies the retreat team should be aware of?
Is there anything else you feel would be helpful to share with the team leadership at this time?
Amount
prevnext( X )
Double Occupancy Room(431 - Office of Family Life)
$350.00



Single Occupancy Room(431 - Office of Family Life)
$400.00



Commuter(431 - Office of Family Life)

$150.00



Total

$0.00
Thank you for choosing to pay online. All payments are processed through PayPal. Payments can be processed with or without a PayPal account. Your payment will reflect as PayPal on your credit card statement. If you have any questions, please contact the Office for Family Life at (714) 282-4203 or lji@rcbo.org. Thank you!
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Life-Giving Wounds Retreat Registration Form

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