Busy Person’s Retreat

First Name *
Last Name *
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Email *
Phone *
Denomination
Food Allergies
Comments or Special Needs
How did you hear about us?
Special Diet	Please note that we are not a peanut/nut-free facility. Many of our breads and other commercial foods we purchase may contain or may come into contact with common allergens, including wheat, peanuts, soy, tree nuts, milk, eggs, fish and shellfish. In addition, the manufacturers of the foods we purchase could change their formulations at any time without notice. Please also note the foods we prepare without gluten ingredients are not certified gluten free. Most of our baked goods and breakfast items contain eggs, dairy and wheat, unless specifically marked otherwise. We are unable to accommodate food preferences while maintaining our commitment to sustainability and care for the environment. We are also unable to accommodate severe food allergies. There is refrigerator space available to accommodate all severe allergies and food preferences not listed above. Thank you for your understanding.
Spiritual Ministry	If applicable, please list any spiritual ministry.
Occupation	What is your current occupation?
Spiritual Exercises *	Yes No Have you made the Spiritual Exercises of St. Ignatius?
Directed retreat experience *	Yes No Have you previously attended a directed retreat?
Spiritual Director Qualities	What qualities would you like in a spiritual director?
Specific Spiritual Director	If you meet regularly with a spiritual director on this retreat and would like this person to accompany you on this retreat, please list their name here. Each retreat director meets with a limited number of retreatants. For this reason we cannot guarantee that the director you specify here is available for you. When your requested director is not available, we will assign you to another director who we see best fit. If you are not open to another director, you are still welcome to attend but please indicate "no director needed".
Preferred Start Date
Preferred End Date
SRC Email newsletter	Please send me St. Raphaela Center's newsletter
Handmaid News	Would you like to periodically receive a newsletter from the Handmaids?
Terms and Conditions *	I have read and agree to the the terms and conditions as detailed below.As part of the consideration for the use of the facilities of St. Raphaela Center at 616 Coopertown Rd, Haverford, PA 19041, and intending hereby to be legally bound, the undersigned organization and/or individuals (as indicated), hereby agree to indemnify, defend, and hold harmless St. Raphaela Center and the Handmaids of the Sacred Heart of Jesus and all of their members, officers, directors, employees, volunteers and agents from and against all claims, suits, actions, demands, charges, obligations, costs and expenses, or financial responsibility, including attorney’s fees and costs of suit, to which it or they may ever be threatened, exposed or found liable arising from or out of the use of the said facilities, or arising out of incident, accident, or injury occurring while the individual or group is utilizing St. Raphaela Center, including but not limited to actions regarding our health and safety guidelines in relation to COVID-19, or any of the acts or omissions of the undersigned or their agents, employees or members. This obligation of undersigned to hold harmless, defend and indemnify shall begin immediately upon notice of a claim and shall not require any actual loss to be suffered by the parties indemnified.

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

Busy Person’s Retreat

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$	St. Raphaela Center Donations contribute to the maintenance of the Center and its mission.
$	Retreatant Scholarship Program Provide the opportunity for others to experience a retreat for whom this would otherwise not be possible.
$	Add 3% to my total amount to help cover the bank fee for processing my credit card. Add 3% to my total amount to help cover the bank fee for processing my credit card.