Retreat Sign In Form – Infinity Marriages

Your Name *

First

Last

Your Email *

Mobile Phone *

Spouse's Name *

First

Last

Spouse's Email *

Spouse's Mobile Phone *

Would you like to remain on the Infinity Marriages mailing list to be kept nofitied of upcoming events? *

Home Address *

Do you have any dietary requirements? *

To confirm your dietary requirements, please type 'yes' or 'no' below *

CONFIRMATION ERROR!

You must confirm your dietary requirements to proceed.

Please give details of your dietary requirements

Does your spouse have any dietary requirements? *

To confirm spouse's dietary requirements, please type 'yes' or 'no' below *

CONFIRMATION ERROR!

You must confirm your dietary requirements to proceed.

Please give details of your spouse's dietary requirements

Do you have any accessibility requirements? *

Please give details of accessibility requirements

Does your spouse have any accessibility requirements? *

Please give details of your spouse's accessibility requirements

Emergency Contact - Name *

Emergency Contact - Number *

Do you have any health conditions we should be aware of? *

Details of health conditions we should be aware of

Does your spouse have any health conditions we should be aware of? *

Details of your spouse's health conditions we should be aware of

Any additional information

Confidentiality *

As a participant on this retreat, I have the authority to submit this form on behalf of my spouse and myself, and assert that we will abide by all moral and ethical principles on confidentiality, privacy and respect, and ensure that any information shared in any of the sessions is not disclosed or discussed outside the sessions.

Terms *

I accept that Infinity Marriages abides by, and upholds the traditional Christian definition of marriage (between one man and one woman) and this may feature in all interactions and communications. All services of The Wellspring and Infinity Marriages are provided in accordance with terms and conditions of service published at https://infinitymarriages.org/terms-and-conditions/