Application for the 8-Day Silent Ignatian Retreat at Singing River Ranch - May 14-22, 2021
This retreat is full -- all new applications will be placed on a waiting list.  Thank you for your understanding.

The application requires a 50% deposit which may be paid by check or credit card. Payment instructions provided at the end of the application.

PLEASE NOTE: For this retreat we are unable to accommodate special food requests.   We are sorry for any inconvenience.
 
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Applicant's Name: *
Applicant's Email Address: *
Applicant's Telephone: *
Applicant's Mailing Address: *
Retreat Length: *
Required
Emergency Contact Name: *
Emergency Contact Relationship: *
Emergency Contact Phone Number: *
For a Better Appreciation of Your Personal Spirituality
[All this information will be kept confidential]
Have you made a silent retreat before? *
Was it personally directed or guided? *
Are you currently in spiritual direction? *
What prompts you to make this retreat? *
What desires, expectations, hopes, fears or concerns do you have for this retreat? *
What have been some of the major influences affecting your personal life/spirituality? And how have they affected you? (Example: Parents/Family) *
Favorite/Scripture/Passages: *
 Moments of major decisions (Vocation/Change/Conflict) Conversion Experiences: *
What is your present ministry/occupation *
Religious Affiliation *
Required
Check One: *
Date of Birth: *
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What Parish do you attend? *
Medical Information Section
Are there any past or current medical conditions or information that we need to be aware of? *
Are there allergic conditions that we need to be aware of? (Including medication allergies): *
Do you currently take medications? If yes, please list medications: *
Will you have any special needs during this retreat? If yes, please explain: *
Do you have medical background/training? If yes, please explain: *
Alternate Emergency Contact Name & Phone Number: *
Health Insurance Company: *
Health Insurance Phone Number: *
Policy Holder Name: *
Group Number: *
How did you learn about this retreat: *
Date of Application: *
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Signature: *
Instructions for completing the application:
* All applications will be reviewed by a staff member of the Lanteri Center    
* Refunds will be issued for those whose applications are not accepted at this time
* Check in is before 5 pm for orientation, schedule review and room assignment. Please make every effort to stay through the end of the retreat on Sunday afternoon

Please submit a 50% deposit with your application.

Instructions for payment will be presented on your screen after you press the SUBMIT button below.

NOTE: to ensure that you receive our retreat updates, please add mail@flocknote.com to your address book.
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