Carpe Diem Arts Adult Retreat

Creative Soul Retreat: January 23-25, 2026

Retreat for female-identifying and non-binary adults 21+ on the Eastern Shore.
* = Required field
How did you learn about Carpe Diem Arts' Creative Soul Retreat for adults?*
If someone told you about camp, please add their name so we can thank them!
Birth Date*

MonthDayYear
Date
This program is for adults, age 21+. Please reach out to us and share your interest in arts programming, and we will see what we can create!
REQUEST HELP: If you face financial hardship and the sliding scale doesn't meet your needs, stop here and contact Beth at 240-203-8941 to discuss additional support options. We want to help make participation possible for you.

HELP OTHERS: If you are in a position to help make the arts accessible to all, please make a contribution after selecting your accommodations.
Type of Accommodation*
Double Occupancy Room - set slider at the amount you can pay
Would you like to make a contribution to support our mission of making the arts accessible to all?
Donation Amount
Hidden Total Amount Due
Total
The retreat is now full. If you wish to be placed on a waitlist, click here. Thank you for your interest in Carpe Diem Arts' Adult Retreats.

Participant Information

Retreat Jan 23-25 2026
Participant Name*

First NameLast Name
Nickname, if any
What pronouns do you use?
Home Address*

Street Address

Street Address Line 2

CityState

Postal / Zip Code
Phone Number*
Best contact number
Email*
example@example.com
Dietary Restrictions - check all that apply

Gluten freeLactose intolerantNut allergyVeganVegetarianHalalKosherOther dietary
Special Interests and Skills
Please list any skills and interests we should know about you.
Additional Information
Please let us know any other information you believe is pertinent, including serious allergies or medical conditions.

Consent & Emergency Information

Retreat Jan 23-25 2026
Consent provisions: Please acknowledge acceptance by clicking on each box below.*

1. Carpe Diem Arts will not tolerate bullying, violence, smoking, illicit drugs, or any other behavior that jeopardizes the emotional and physical well-being of our participants.2. I will be courteous of others. If I am sick, I will contact the Retreat Facilitator to cancel, if in advance of the retreat, or if the program has begun, remove myself from the premises if deemed necessary by the Retreat Facilitator.3. I will be respectful of the property owners and will report and be responsible for any damages I may cause.4. I hereby release and discharge Carpe Diem Arts, Inc., its staff and volunteers from all claims of liability for any damages or injuries I may sustain while at the Retreat. Further, I hereby release from liability the property owners upon whose land and facilities the Retreat will be located.5. I hereby give permission to Carpe Diem Arts, Inc.'s Adult Retreat staff to transport me off the Retreat property for medical care as deemed necessary by the Retreat Facilitator. I understand that every effort will be made to reach my Emergency Contact, listed below.6. I do hereby give authority to the aforementioned parties to obtain the necessary emergency medical treatment for me by EMT and/or at the nearest hospital with the understanding that my Emergency Contact will be notified as soon as possible.7. I understand that the Retreat does not provide accident/medical insurance for participants, including me. Medical bills, including prescription drugs will be my responsibility.
Emergency contact*

First NameLast Name
Phone Number for Emergency contact*
Best contact number
Email for Emergency contact*
example@example.com

Payment Information

Retreat Jan 23-25 2026
Will you be paying by...*

CheckCredit CardPayPal

Check Payment Information

Retreat Jan 23-25 2026
To pay by check, please make check out to Carpe Diem Arts, Inc. and mail to:

Attn: Retreat
Carpe Diem Arts
9207 Long Branch Parkway
Silver Spring, MD 20901

Check must be received within 10 days of registration or the reservation will be released.
$ Amount to pay today
Check #*
Signature: I certify payment in the amount above has been made. If I selected an installment plan, I agree to make any additional monthly payments required and I may be invoiced for those installments by email to the Parent/Guardian email address provided. *

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Directions and more details regarding the retreat will be sent to you prior to the Retreat

NOTE: If you wish to print the form, please do so before clicking the Submit button

PayPal Payment Information

Retreat Jan 23-25 2026
Amount to pay
If you have the PayPal mobile app,
please make payment by scanning the QR code.
Or, make payment at https://www.paypal.com/paypalme/carpediemarts

IMPORTANT NOTES

If your Payment choice takes you to the Payment app (like PayPal does), you MUST return to vendor (us) to complete your registration by hitting Submit - or you will not be registered.

Directions and more details regarding the retreat will be sent to you prior to the Retreat.

If you wish to print the form, please do so before clicking the Submit button.
Signature: I certify payment in the amount above has been made via PayPal.

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Credit Card Payment Information

Retreat Jan 23-25 2026

Please verify that you are human*
Signature: I certify payment in the amount above has been made.*

Clear
Directions and more details regarding the retreat will be sent to you prior to the Retreat

NOTE: If you wish to print the form, please do so before clicking the Submit button
Should be Empty:

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Creative Soul Retreat: January 23-25, 2026

Participant Information

Consent & Emergency Information

Payment Information

Check Payment Information

PayPal Payment Information

Credit Card Payment Information