Retreat Name:

Summer or Advent Family Retreat Registration:
1st Choice 2nd Choice 3rd Choice

Fields marked with a asterisk (*) are required!!

 
*Last Name
*Familiar Name
(For Name Tag)
Sex
(M/F)

D.O.B.
(mm/dd/yy)

Religion
Occupation
APPLICANT
SPOUSE (if applicable)

 

FOR FAMILY RETREATS, PLEASE LIST CHILDREN ATTENDING IN DESCENDING ORDER OF AGE

 

AGE at time of RETREAT
Oldest Child
Crib?
Next Oldest
Crib?
Next Oldest
Crib?
Next Oldest
Crib?
Next Oldest
Crib?
Next Oldest
Crib?

 

APPLICANT MAILING ADDRESS: (Is this a address Change?)
*Street Adress: *City: *State: *Zip Code:

*Email Address: *Home Phone: Work Phone:

Cell Phone #1: Who's is it: Cell Phone #2: Who's is it:


How(or from whom) did you hear about this retreat?
Special Needs: Example Mary (first floor room) or Peter (peanut allergy)
Musical Talents:  Example Elizabeth (voice) or Mike (guitar)

First-Timer at Mary’s House? If ‘No’ please list dates and names of retreats

Financial Aid Requested?
If Checked, A Finacial Aid Form Will be Sent To you.

Additional Information for Family Retreats
:
Please write a brief description of your family and their primary interests and what your expectations for this retreat might be.


Additional Information for Couples Retreat:  Wedding Date  



Select Retreat Deposit
Mother/Daughter Retreat