HTIC Retreat Attendee Questionnaire

First Name

Last Name

Please provide an emergency contact. (Name, Phone & Address)

Please provide any food allergies or medical conditions we should be aware of.

What motivated you to attend the retreat? (Describe your story)

What are your expectations of the retreat?

Name up to 3 goals you have for yourself entering the retreat?

Would you like options for lodging at the Ballantyne Hotel?

Yes

No

Please select up to 3 dates/time you are available for your pre-retreat counseling session. (Each sesson will last 1 hour)

Monday October 18th - Morning

Monday October 18th - Afternoon

Monday October 18th - Evening

Tuesday October 19th - Morning

Tuesday October 19th - Afternoon

Tuesday October 19th - Evening

Wednesday October 20th - Morning

Wednesday October 20th - Afternoon

Wednesday October 20th - Evening

Thursday October 21th - Morning

Thursday October 21th - Afternoon

Thursday October 21th - Evening

Friday October 22nd - Morning

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