Ahdama for Couples Application Form:
This application has been created so that we might better understand you and your needs. All the information shared on this form 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 ever participated in similar events? If your answer is no, why have you decided to participate now?
*
What would make this retreat a successful experience for you both?
*
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 you currently working with a coach or therapist?
Yes
No
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 else you would like us to know about you?
Submit
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