9th Annual Women's Retreat

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

May 25-29, 2024 (four nights) - Big Bear Retreat Center

Email *

First Name: *

Last Name: *

Street Address

City, State, Zip

Phone number: *

What are your pronouns?

Accommodation Information

Snore

CPAP User

Chemically Sensitive

Mobility Issues

Other:

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. *

Vegan

Gluten-free

None

Other:

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 Big Bear Retreat Center from May 25-29, 2024 in Big Bear, 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. *

I agree

I disagree

By typing your name here you agree to the above Waiver of Liability and the Cancellation Fee Policy listed on the payment page *

Date

YYYY

Room selection
*

$645 - Triple Shared Room

$730 - Double Shared Room

$815 - Single Room / Shared Bath

$945 - Single Room / Private Bath

Requesting a Scholarship (we will contact you)

Clear form

Never submit passwords through Google Forms.

This form was created inside of Mary Stancavage. Report Abuse

Forms