OLD---Directed Retreat Reservation Form

Directed Retreat Reservation Form
Title (Ms., Mr., Dr., Sr., Rev., etc.):*
First Name:*
Last Name:*
Date of Birth:

MonthDayYear
Date
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Day Phone Number:*

Area CodePhone Number
Evening Phone Number:

Area CodePhone Number
Email:*
example@example.com
Parish or Church:
Arrival Date:*

MonthDayYear
Date
Arrival Time: You may arrive at any time. If the time you give us changes for any reason, please contact the Reservations office as soon as possible.*

:HourMinutesAM/PM Option
Departure Date:*

MonthDayYear
Date
Departure Time: You may depart at any time. If the time you give us changes for any reason, please contact the Reservations office as soon as possible.*

:HourMinutesAM/PM Option
For health reasons only, I prefer a room:
Do you have any Extreme Food Allergies; Health Issues (e.g. Diabetes, Celiac) - Not Food Preferences? If so, please explain:
YesNo
If Yes, Date of last retreat:

MonthDayYear
Date
YesNo
Religious affiliation:
What is your present ministry or occupation?
What characteristics or qualities are you looking for in a director?
We try to honor your request for a specific director whenever possible; to assist us in assigning directors, let us know if you have a preference:
Additional Information/Requests
The Retreat House will be closed on the following dates:
August 28 through September 5, 2022
December 14, 2022 through January 1, 2023
August 27 through September 4, 2023

We require a $50.00 non-refundable deposit at the time of registration. Your deposit is applied to the final balance of your payment.

If you are making an 8-day retreat, we also give you the option to pay for your entire 8-Day retreat ($960.00) up front if you so desire.

If paying by check please mail your payment to:

Sacred Heart Retreat House
Reservations Coordinator
P.O. Box 185
Sedalia, CO 80135

When paying by check please print out a copy of your reservation receipt and include it with your check. This will guarantee that your deposit is properly credited to you.

(Please note that if you pay by check your registration will not be complete until we receive your payment.)

If you would like to pay by credit card now, please use the form below and choose only one option.

To pay by credit card please choose ONE OPTION below:

Directed Retreat Non-Refundable Deposit$50.00

8-Day Directed Retreat Full Payment$1,040.00

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Should be Empty: