Required information is marked with an * Awaken Our Spirit Retreat Registration Awaken Our Spirit Retreat Registration Parent / Guardian Information Parent / Guardian 1 * Parent / Guardian 1 First First Last Last Date of Birth * Gender * Female Male Cell Phone Home Phone Email * Address Address Address Address City City Province Province Postal Code Postal Code First Nation Treaty Number Sask Health Number # of Children Attending Retreat * Parent / Guardian 2 Parent / Guardian 2 First First Last Last Date of Birth Gender Female Male Cell Phone Home Phone Email Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal First Nation Treaty Number Sask Health Number List of Children Registering for the Retreat (Click the Add Button for additional children.) Name * Name First First Last Last Date of Birth * Gender * Female Male First Nation Treaty Number Saskatchewan Health Number Any Allergies * Yes No If yes, please list. Any Medications? * Yes No If yes, please list. Any health conditons we need to know about? Behaviors / Conditions / Addictions / Learning Disability / Mental Health Issues Has the child / youth ever received support from a doctor / counsellor / Elder? * Yes No If yes, name of provider and description. Add Remove Family Issues and Expectations Please briefly describe your family. What kind of difficulties are you facing? * What are your expectations from the Retreat? * Retreat Selection. Please select one. Subject to approval and / or availibility. (Two-Week Retreats are at $2,750.00 per participant. Funding is available through Jordan´s Principle.) If you require assistance with funding contact us toll free at 1 888 270 2967. Retreat Dates * Monday July 18, 2022 to Friday July 29, 2022 Monday August 1, 2022 to Friday August 12, 2022 Monday August 22, 2022 to Friday September 2, 2022 I hereby give permission to use pictures of my child taken during the retreat, to be used for advertising and promotions of Awaken Our Spirit: Yes No Agreement to Terms and Conditions. I hearby agree to the best of my ability that all information on this application is accurate. I also agree to abide by all terms and conditions as layed out upon arrival at the Retreat. * Yes No Signature * Clear Date * If you are human, leave this field blank. Submit
