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R.E.D.! Participant Registration Form!
R.E.D! Wellness Retreat: Rejuvenating Evening of Development Registration
Monday, May 13, 2024, 7pm
Delta Grand
Opelousas
FMI call 337-381-3366 or 337-290-3723
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Name
*
Your answer
Phone number
*
Your answer
Email
Your answer
Address
*
Your answer
What is your age?
*
Your answer
What do you hope to get from the Wellness Retreat?
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Ideas for healthy living and exercising
Time to rest and recharge.
Networking with other moms
Spiritual Guidance
Self-care techniques
Furthering your education
Break from the stress of children
Learning to be a medical advocate
Other:
Required
How did you hear about the retreat?
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Newspaper
Flyer
Friend
Social Media
Television
Radio
Mailer
Work
Family Strong Foundation table at an event
Other
General Liability Release:
Family Strong Foundation, sponsors, and venue are not responsible for personal nor property damage. All scheduled events are subject to change. Do you agree to the terms?
*
Yes
No
General Liability Release:
During the retreat, I agree that my photos and quotes may be used for publicity purposes.
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Yes
No
General Liability Release:
In case of an emergency, I hereby authorize myself to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician).
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