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ABORTION  •  HOPE RETREAT REGISTRATION

Please note this retreat is small and intimate. The amount of participants at one session will be 6-8. Upon your confirmation we begin our plans for you. Please make all attempts to coordinate (work, childcare, personal appointments, and church commitments, etc) around the dates. We have a waiting list and hope to accommodate all who are interested. The Next HOPE Retreat is scheduled for March 26-28, 2010. Please answer the following questions.

First Name
Last Name
Phone
Email
Address
City
Zip
How did you hear about the retreat?
Do you attend a church? YesNo
If so what is the name of your church? (not mandatory to have a church association)
How many abortions do you have in your past?
How long ago was your abortion experience(s)?
What do you hope to gain by attending the Hope retreat?
What are some foreseeable obstacles for you attending the retreat?
Would you prefer to be contacted via Email or US Mail? EmailUS Mail
May we leave you a detailed message on the phone number you gave us? YesNo
What would you rate your emotional/spiritual health on a scale of 1-10?
Please explain your emotional/spiritual health?
Are you able to attend the retreat from Friday 5pm- Sun 1pm? YesNo
Do you have any physical limitations to limit you from minor physical actions? YesNo
Will you have a friend or prayer partner to support you during this retreat? YesNo
Do you have a Bible? YesNo (If no, we can provide a Bible)
Are you currently in sessions with: a Professional, Lay, or Spiritual Counselor at this time? YesNo
Are you currently pregnant, going through fertility treatment or an adoption process? YesNo
All class discussion is confidential; will you have trouble committing to the anonymity? YesNo
Please share with us your birthdate (06/18/1966),
Comments

Please help us by checking employment, health issues, church commitments, childcare and personal engagements before signing up for this important retreat. By checking this box you acknowledge how important your registration commitment is to our organization.

You will receive a confirmation email to declare your space and to give the location, date, and time information. Filling out this form does not automatically place you in the next retreat. We usually have a waiting list, and ask you to let us know as soon as possible if you will not be able to attend. We are liable for all charges if you commit to coming and do not attend.

*Please note this retreat is a small and intimate setting with a total of 6-8 participants. Upon your confirmation we begin our plans for you. All accommodations, meals and supplies are included. There are no fees for this retreat. Please note dates and locations are subject to change.

If you have any questions please contact hope@mycpc.org or call Shirley at 650-964-8093.