Women's 8th Annual Retreat; Big Bear Retreat Center
February 22-26, 2023 (four nights)
Sign in to Google to save your progress. Learn more
Email *
Name: *
Street Address
City, State, Zip
Phone number: *
What are your pronouns?
Accommodation Information *
Required
If you are attending with a partner/friend/family member, please list here:
Are there any medical needs/allergies  we should know about?   *
Are there any other situations we should be aware of?
Dietary Restrictions? All meals served are vegetarian. *
Required
Please give us the name and phone number of your medical doctor. *
Pleases list any medications. *
Who is your emergency contact person and what is their phone number? *
Waiver of Liability: I acknowledge that I have voluntarily agreed to participate in the Women's Retreat offered by Meditation Coalition at the Joshua Tree Retreat Center from January 16-19, 2020 in Joshua Tree, CA. I realize that all activities at Mediation Coalition retreats are voluntary and entirely at my discretion. These may include activities such as a daily work period, movement classes and nature walks. I also am aware that this retreat will take place in a mountain setting and that there may be risks involved in activities on this terrain. I hereby assume all risks of injury to me and my property that may be sustained in connection with activities undertaken while at this retreat. I am also aware that this is a silent meditation retreat and participants may experience intense psychological, spiritual and/or physical states of mind and body arising from the meditation and associated retreat activities. I am voluntarily participating in these activities with full knowledge of the risks involved.I have read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between myself and Meditation Coalition. *
By typing your name here you agree to the above Waiver of Liability and the Cancellation Fee Policy listed on the payment page *
Date *
MM
/
DD
/
YYYY
Are you requesting a single room? (This will add $225 to the level you choose below.) *
At which level are you paying? $295 covers the cost of room and board. Any amount you offer above that will support scholarships for those who may not be able to attend retreats without support. We hope to make these retreats available to all to wish to attend. *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Mary Stancavage. Report Abuse
Google Forms