Directed Retreat Application Form

Name:     First / Middle / Last
Address:
City:       State: ZIP:
     
Home Phone:    ()         
Office Phone:    ()         
Email:               
Occupation/Ministry:
Date of Birth: //
Name of Parish:    City/Town of Parish:
Emergency Contact:     Phone Number: ()
     
Check all that apply:

Religious Sister  Yes  No
Religious Brother  Yes  No
Permanent Deacon  Yes  No
Priest  Yes  No
Seminarian  Yes  No
Lay Person  Yes  No

Is this your first directed retreat?  Yes  No
     

Retreat Date:       June 21-27, 2009                 July 10-16, 2009 

Retreat Type:

Directed $380.00 (Full)    Directed $60.00/Day (Partial)
     
PLEASE COMPLETE THE FOLLOWING QUESTIONS

(Your brief responses will be helpful in selecting a director and for the benefit of your director. All information will remain confidential)

1. List your retreat experience for the past 3-4 years (e.g. directed, guided, weekends, etc. with location and year).

2. If you have a spiritual director, how often do you visit?

3. How have your most recent retreats impacted your life?

4. How comfortable are you with maintaining silence during your retreat?

5. List any health or special needs you may have.

 

In order for us to reserve your place for the retreat, you must send a non-refundable deposit of $75 made payable to
Our Lady Queen of Peace Retreat Center.

Please mail to:
Our Lady Queen of Peace Retreat Center
3630 Dancyville Road
Stanton, TN  38069-4711