Fall 2024 Online Retreat Registration

Important note: Once you complete the form below, you will then need to hit the “Next purchase ticket and add-ons” button to select the appropriate ticket and check out. Your registration is not finalized unless you complete the full checkout process.

Name

First Name

Last Name

Best email for correspondence during the retreat

Age

We collect this information to ensure everyone is over 18 and to help form small groups. No one under age 18 is permitted to attend the retreat.

Phone

Country

(###)

###

####

Emergency Contact Name

We'll only use this contact in the case of a medical or mental health emergency.

First Name

Last Name

Emegency Contact Phone Number

(###)

###

####

What diocese or college do you belong to? (If not applicable, then put your city and state.)

Have you discussed your family wounds with a counselor, priest, or a trusted friend?

We believe our retreat is a great complement to counseling, spiritual direction, and/or ongoing conversation with trusted friends. Knowing this information helps us to best serve you during the retreat.

Yes

Do you feel emotionally and psychologically capable at this time to attend an event where strong emotional content about family life will be discussed, shared, and processed?

If you are seeing a counselor or psychologist, then please consult first with him or her about whether he or she believes it is a good time for you to attend a retreat like this one.

Yes

Parents' relationship status

This helps us to ensure you are the right fit for this specific retreat. If you check any below, then the retreat is for you. If you do not fall into these categories, then please contact us to discuss.

When did your parents divorce or separate? (Don't know? Then put "unsure." And put n/a if not applicable.)

How old were you?

Your relationship status

This helps us form small groups and tailor the content of the talks to our audience.

Religious affiliation

While we are a Catholic retreat, we welcome anyone seeking God and collecting this information helps us to best serve you.

How did you hear about the online retreat?

If you answered "Other" above, please let us know how you heard about the retreat:

Are any family members, a significant other, or friends attending this event with you? If yes, list their name(s) here and let us know if you'd like to be in the same small group as them or not.

Note that every person attending the retreat should register individually, so they can receive their retreat materials.

Would you like to opt out of small groups (leave unchecked if you plan to attend the small groups)?

Yes

Is there anything else you feel would be helpful to share with the team leadership at this time?

Fall 2024 Online Retreat Registration

Life-Giving Wounds

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