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Personal Retreat Registration
January 6 - 10, 2025
Co-Ed Personal Retreat
Name
*
Prefix
First Name
Last Name
Suffix
How would you like your name to appear on your name tag and materials?
*
Email
*
Verify Email
*
Cell Phone
*
Landline (optional)
I would like a text reminder about this retreat.
*
select one
Yes
No
Address
*
Address Line 1
Address Line 2
City
City
State
State/Province
ZIP/Postal Code
Country
Birth Date
*
To assist with room assignments, please enter your birthdate. (mm/dd/yyyy)
Gender
*
To assist with room assignments, please enter your gender.
select one
Male
Female
Prefer not to answer
Retreat Contributions
*
Quantity
$100
-
1 Night Personal Retreat - Non-refundable Deposit per Retreatant
0
1
1
$100
-
2 Night Personal Retreat - Non-refundable Deposit per Retreatant
0
1
1
$100
-
3 Night Personal Retreat - Non-refundable Deposit per Retreatant
0
1
1
$100
-
4 Night Personal Retreat - Non-refundable Deposit per Retreatant
0
1
1
$170
-
1 Night Personal Retreat - Suggested Contribution per Retreatant
0
1
1
$300
-
2 Night Personal Retreat - Suggested Contribution per Retreatant
0
1
1
$450
-
3 Night Personal Retreat - Suggested Contribution per Retreatant
0
1
1
$600
-
4 Night Personal Retreat - Suggested Contribution per Retreatant
0
1
1
I want to make an additional donation:
$
Emergency Contact Name
*
Emergency Contact Relationship
*
Emergency Contact Phone Number
*
Are you part of a parish/church?
*
select one
Yes
No
Don't know
Enter parish/church name
*
Are you part of a retreat group?
*
select one
Yes
No
Don't know
Enter group name
*
Do you have a room request based on medical needs?
*
Yes
No
Please enter brief reason for room request, e.g. CPAP machine, limited mobility, etc.
*
Bathrooms are assigned based on age or medical needs. Only 20% of our rooms have ensuite bathrooms.
Have you attended a Bellarmine weekend retreat in the past three years?
*
Yes
No
Do you want to meet with a Spiritual Director?
*
Yes
No
Can you go up/down stairs for Spiritual Direction?
*
Yes
No
Do you have any dietary restrictions?
*
You are welcome to bring your own food. A refrigerator and microwave are available for your use.
None
Vegan
Vegetarian
Gluten free
Dairy free
Other
Other - Please enter information regarding any other food allergies.
*
Payment Information