Ahdama Couples Application
This application helps us get to know you, your relationship, and what you're hoping for. Everything you share will remain completely confidential.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Are you a returning participant?
*
Yes
No
Age
*
Where do you live? (City and Country)
*
Which Remembrance are you applying for?
*
Nov 5-8
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Do you have any food allergies or dietary restrictions? (All Food Is Kosher)
*
How would you describe the current season of your relationship?
Why would you like to attend this couples retreat? (Be as specific as possible. Your answers are confidential)
*
Have you participated in a couples retreat or similar experience before? If yes, what was most valuable? If no, what led you to apply now?
*
If you looked back six months after the retreat and said, "It was absolutely worth it," what would be different in your relationship?
*
Do you have any medical conditions (mental and/or physical) that we need to be aware of?
*
Are you taking any prescription medications?
*
What is your relationship with substances? Do you have a history of substance abuse?
*
Are either of you currently working with a coach, therapist, or mentor?
Yes
No
If yes, is there anything from that work that would help us better support you?
Do you commit to respecting the space and keeping confidentiality?
*
Which investment range best reflects where you are as a couple for a high-level, facilitated retreat experience?
*
$4,000–$5,000
$5,000–$7,000
We’re open but need clarity
This may not be the right time financially
Is there anything important that would help us better support you during this experience?
Submit
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