Womens ACTS Retreat Application - St. Edmond Catholic Church

Women's ACTS
Retreat Application

Retreat Dates: October 17th – 20th, 2024

Retreat Dates:
October 17th – 20th, 2024

Simply fill out your information in the form below to apply for the upcoming Saint Edmond Women’s ACTS Retreat.

Please Note:

Space is limited. ACTS is a “parish based” retreat and ministry. Registration is open first to parishioners of St. Edmond before considering non-parishioners. When we have reached the maximum number of retreatants, a waiting list will be utilized up to 10 days before the retreat to fill any vacancies.

Retreatant Information

First Name

Last Name

Preferred Name on Tags

Date of Birth

Phone Number

Church Parish

Religion

T-Shirt Size

Referred By

Retreatant Address

Street Address

Street Address Line 2

City

State

ZIP Code

Spouse Information

Marital Status

Spouse's First Name

Spouse's Last Name

Phone Number

Primary Contact Details

First Name

Last Name

Relationship to You

Phone Number

Emergency Contact Details

(If spouse or primary contact cannot be reached)

First Name

Last Name

Phone Number

Medical Information

(Medical or dietary needs during the weekend)

Do You use a C-PAP Machine?

Yes No

Do You use a Wheelchair?

Yes No

Please let us know if you have any allergies, existing illnesses or any medical conditions.

Are you currently taking any medication?
If yes, please provide the generic name and its purpose.

If you have any dietary needs, please explain.

Disclosure

I understand that ACTS Missions will collect all retreatant's information for quality purposes and testimonials. I also understand that ACTS Missions may contact me after this ACTS Retreat to get feedback on my experience and see if I would like to participate and support future ACTS Retreats. I understand that ACTS Missions will NOT release my personal information to outside agencies.

I have read the above statements.

I would like to participate in the follow-up initiatives. I would not like to participate in the follow-up initiative.

Saint Edmond

Catholic Church

Saint Edmond

Catholic Church

Saint Edmond
Catholic Church