5-Night Individual Retreat

* These fields are required

1 Welcome

2 Choose the dates of your stay

3 Price

4 People in your group

Guest 1		First Name* Last Name* Email* Phone*
Guest 1		First Name* Last Name* Email* Phone*

Continue

5 Participant Info

Phone *
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Birth Date
Gender
Are you Catholic?
If you are of another faith, please specify:
Please identify if you are a priest, deacon, seminarian, or religious:
Have you ever made a Directed Retreat? *	Yes No This could be at any retreat house, does not have to be at OLPH.
If you have attended a directed retreat previously, when was your last directed retreat?	If you have attended a directed retreat previously, please give the dates of your most recent directed retreat.
If you have attended a directed retreat previously, what type of directed retreat did you attend?	If you have attended a directed retreat previously, what type of directed retreat did you attend? ie, Ignatian, Thematic, Contemplative or Silent, Parish or Community, Ministry, etc.
If you have attended a directed retreat previously, what was the duration of your most recent retreat?	If you have attended a directed retreat previously, how long did your most recent retreat last?
Are you currently receiving Spiritual Direction? *	Yes No Do you currently meet with a Spiritual Director?
If you are receiving Spiritual Direction, how long have you been receiving Spiritual Direction?	If you are receiving Spiritual Direction, how long have you been receiving Spiritual Direction?
If you are receiving Spiritual Direction, how often do you meet with your Spiritual Director?	If you are receiving Spiritual Direction, how often do you meet with your Spiritual Director?
Why are you wanting to make a retreat at this time? *	Why are you wanting to make a retreat at this time?
What hopes, desires, fears, or concerns do you have this retreat? *	Please share with any hopes, desires, fears, or concerns you have for this retreat.

Continue

6 Dietary Preferences

Special Diet	There is an additional fee of $15/day for Special Diets.
Diet Notes	Do you have any allergies or other dietary restrictions? Please note that we may not be able accommodate all dietary requests.

7 Additional Information

Do you have any medical issues? *	Yes No
Please tell us more about your medical Issues
Comments or Special Needs

8 Emergency Contact Information

Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone Number
I understand that my deposit is 100% non-refundable.	I agree
Email newsletter	Please send me the email newsletter
How did you hear about us?

9 Donate

$	Oblates of the Virgin Mary Donation to the Oblates of the Virgin Mary
$	OLPH General Fund General Doantion to OLPH
$	OLPH Conference Center Artwork Donation to help purchase artwork for the Conference Center

10 Security Check

Security check

11 Payment

Payment processing fee	I agree to cover the costs of processing this registration by paying the payment processing fee.
3% Payment processing fee	$0

Sub Total	$0

Donations	$0

Taxes	$0

50% Deposit	$0

Pay	Choose to pay a deposit or the full amount right now.

Due Now	$0 $0

Remaining Balance	$0

Choose Payment Option

	Your registration will be complete once we receive your payment. Click on the button below and these instructions will be repeated on the next page.

	By submitting payment, you authorize Our Lady of Perpetual Help Retreat and Spirituality Center to instruct your financial institution to take payments from your account in accordance with your agreement with Our Lady of Perpetual Help Retreat and Spirituality Center.

5-Night Individual Retreat

1 Welcome

2 Choose the dates of your stay

3 Price

Select an option*

Single Occupancy (Twin Bed, Private Bath)

4 People in your group

5 Participant Info

6 Dietary Preferences

7 Additional Information

8 Emergency Contact Information

9 Donate

10 Security Check

11 Payment