Register for a Retreat

The retreat and registration process is confidential and all of your information is confidential!

It is important that you make a commitment to stay for the entire weekend. Missing any part of the retreat will interfere with the closure you seek. Consider this weekend a special gift that you are giving to yourself.

Which retreat do you want to register for?(Required)

Click here for upcoming retreat details

Name(Required)

First Last

Do you prefer to be called by a nickname?

Address(Required)

Street Address City State ZIP Code

Phone(Required)

Email(Required)

How would you prefer to be contacted?

In case of emergency during the retreat, who should we contact?

Emergency contact name

First Last

Emergency contact phone

Emergency contact's relationship to you

Age(Required)

Marital status(Required)

What religious faith are you?(Required)

How did you hear about this retreat?(Required)

Do you need financial assistance to attend this retreat?

If yes, how much are you able to pay?

How long has it been since your abortion?

How old were you?

Indicate the number of:

Abortions

Miscarriages/Stillborns

Do you have living children?

How many, and what are their ages?

Is your spouse/partner the father or mother of the aborted child?

Would your spouse/partner be interested in attending the retreat with you? (All spouses are welcome to attend)

If your spouse/partner wishes to attend, please have him/her register separately.

Have you kept the abortion a secret?

Have you had any counseling or therapy regarding the abortion?

Was the counseling or therapy helpful?

Have you ever been diagnosed with any emotional or psychological disorder(s)?

If yes, what was the diagnosis?

Do you have any special needs (hearing, sight, mobility), medical, or dietary needs? Are you allergic to scents such as perfumes or flowers?

Anything you would like to share about yourself? (hobbies, work, pets, etc.)

Do you have any questions or concerns?

Would you like to pay some/all of the retreat fee online securely?

Payment Amount(Required)

The total retreat fee is $180. You can pay some or all of this fee right now via credit/debit card, and pay the remaining amount with another method later.

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