MARRIAGE RETREAT
DISCONNECT so you can RECONNECT If you have any questions please feel free to email, call or text steveii@campironsights.com (907) 717-7556.
Couple Application
Please fill out the following information as complete as possible
Husband Name
*
First Name
Last Name
Wife Name
*
First Name
Last Name
How did you hear about the Marriage Retreat?
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Husband Phone Number
-
Area Code
Phone Number
Wife Phone Number
-
Area Code
Phone Number
Husband Email
example@example.com
Wife Email
example@example.com
Wedding Date
Husband Date of Birth
Wife Date of Birth
Husband Shirt Size
Wife Shirt Size
Please upload a current picture of the two of you.
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If you have children, how many and what are their ages?
Please describe your (Husband) Faith Preference (Denomination), how often you attend church (What church) and where you are at in your walk with God.
Please describe your (Wife) Faith Preference (Denomination), how often you attend church (What church) and where you are at in your walk with God.
Please list any allergies you might have or medications we should be aware of for this remote setting.
This is a substance free event, If you are selected to attend the retreat are you willing to leave all substances like marijuana, alcohol and other drugs in town and not partake in those while at the retreat?
Yes
No
Have either of you ever been treated for or struggled with any of the following? Please select all that apply
Depression
Anger
Mental Health Issues
Substance Abuse
Other
If you selected any please explain
Is this your first marriage? If not please explain.
Family Annual Income
$0 - $25,000
$25,000 - $50,000
$50,000 - $100,000
$100,000 - $150,000
$150,000 - $200,000
$200,000 +
Payment Source
We can pay the full tuition for the retreat $5000 per couple
We can pay half of the retreat tuition, $2500 per couple, and would like to apply for a scholarship for the rest
We need 100% financial assistance to attend the retreat
Please describe any additional payment options not listed above that may fit for you.
If you want to apply for financial assistance, please describe any financial hardships that you and your family may be going through
This is what we'll primarily use as a determining factor on who is awarded the scholarships for the retreat.
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Your answers to the following questions is what we primarily use as a determining factor of admittance to the retreat. The more in-depth and detailed your explanations the better chance of being accepted for the retreat.
Please describe the status of your relationship and any struggles you may be facing (whatever you are comfortable sharing is fine, this information will remain confidential between the hosts).
Family Loss, Addiction or Substance Abuse Issues, Depression, Issues with Children, Infidelity, Struggles with Faith, Disconnected Relationships, Unfullfilled Needs etc.
What do (Husband) you hope to get out of this retreat
What do (Wife) you hope to get out of this retreat
Please share anything else that you feel would be helpful in our selection of attendees for this retreat.
Again, the more you can explain the better your chance of admission. We have very limited spots available.
Submit
Thank you for filling out the application to attend Camp Iron Sights Marriage Retreat
www.campironsights.com PO BOX 220563 Anchorage, AK 99522 (907) 717-7556 steveii@campironsights.com
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