Registration

Request

We are so excited that you are considering allowing us the honor of your attendance at one of our retreats! Because we believe that each guest deserves to be well served, seen, and loved, we serve a limited number of guests each retreat. Each booking is based upon order of completed registration. Please complete the registration form below, confirm availability for dates, and leave the rest to us!

Name

First Name

Last Name

Date of Birth

YYYY

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact:

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Medical Conditions/Allergies

Please list any food/allergies or medical conditions you may have that we need to be aware of.

Diet restrictions

Please list any diet restrictions or special considerations you would like us to be aware of.

Security

Safety is important! Please disclose if there are safety concerns, active restraining orders, or any other important information that may affect your safety or that of our other guests/ministry team.

You are loved, worthy, and wanted

Please describe, as you feel comfortable, your reason/desire for attending our retreat.

Desired Retreat Date

Please list which retreat date you would ike to attend

YYYY

*Please note that childcare is not provided at this time. Retreats begin on a Friday evening and conclude on Sunday at noon.

Registration

Request

Ezer Kenegdo Foundation