2022 Retreat Waiting List

Retreat Name

First Name (list both for Couples)

Last Name

Address

City/Town

State

Zip/Post Code

Phone Number

Parish Name

Accessibility:
1st Floor Room
1st Floor Room w/ Bathroom Assistance Bars
Handicapped Accessible Room

Please indicate if you use:
Cane
Walker
Wheelchair

Special Dietary Requests: We will accommodate requests as able; please bring items to supplement.

Questions or Comments (optional)