2025 Prayer Retreat Registration

RETREATANT INFORMATION

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Birthday REQUIRED Please fill out this field. Please enter valid data.

Age REQUIRED Please fill out this field. Please enter valid data.

If you are a minor (under 18 years old), please provide your parent's email below. REQUIRED

If this does not apply to you, please type "N/A".

Please fill out this field. Please enter valid data.

Place of Birth REQUIRED Please fill out this field. Please enter valid data.

Citizenship REQUIRED Please fill out this field. Please enter valid data.

Mailing Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Email REQUIRED Please fill out this field. Please enter an email address.

Mobile Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parish Name & City REQUIRED Please fill out this field. Please enter valid data.

Your Current Academic Level / Profession REQUIRED Please fill out this field.

Father's Full Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Full Name REQUIRED Please fill out this field. Please enter valid data.

I am a single, Catholic woman. REQUIRED Yes No Please fill out this field.

Have you attended other types of retreats before? REQUIRED Yes No Please fill out this field.

If yes, please share which types of retreats you have previously participated in: Please enter valid data.

Why would you like to attend this retreat? REQUIRED Please fill out this field.

Retreatant Photo REQUIRED I have uploaded the photo to the link below I will upload the photo after I submit this form Please fill out this field.

Upload Retreatant Photo

TRANSPORTATION INFORMATION

I will need transportation to & from the airport. REQUIRED Yes No Other (please explain below) Please fill out this field.

If YES, please email your itinerary to [email protected]. Please include the airline, flight number, & confirmation number.

Please explain your pick-up/drop-off requests below, if any.

CONSENTS & AGREEMENTS

Liability Waiver:
In participating in this event, the Prayer Retreat hosted by the Dominican Sisters of Mary Immaculate Province on March 20-23, 2025 in Houston, Texas, I acknowledge that I participate on my own time and of my own choice. I assume all risks in connection thereto and hereby release the Dominican Sisters of Mary Immaculate Province, all volunteers, and any additional people who have and will accompany me in this Prayer Retreat from any and all liability connected with my participation. In agreeing to the terms and conditions, I certify that all information contained herein is true and accurate to the best of my knowledge.

I Agree Please select this field.

Video/Photography Consent Statement:
I understand that photos and videos (individual and group) will be taken during this event. I give permission for photographs and videos of myself to be used for promotional materials (web page, newsletters, social media, presentations, etc.) in highlighting the event.

I Agree Please select this field.

EMERGENCY INFO & MEDICAL NEEDS

Name of contact in case of emergency REQUIRED Please fill out this field. Please enter valid data.

Relationship to Retreatant REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Health Concerns (e.g. allergies, special needs, dietary requests, etc.) REQUIRED Please fill out this field. Please enter valid data.

Please kindly note that we are unable to prepare special meals for retreatants. It will be the retreatant's responsilibity to be aware of her own allergies and dietary needs. Thank you.

RETREAT DONATION (optional)

To assist with expenses pertaining to the retreat, a humble donation of $25 is requested. However, this is optional because we understand that some retreatants have financial restrictions and/or will have flight expenses.

If you are donating by check: Please make out your check to "Dominican Sisters" and include the attendee's name on the memo line or in a note with the check. (Please mail check to: Vocation Office, 5250 Gasmer Dr., Houston, TX 77035).

If you are donating by credit card: Please submit donation below.

Thank you kindly for your generosity!

Donation Amount $ Please enter a positive decimal.

Offset Service Fee Please add 3% to help offset processing fees. Not this time, thank you.

Do you have any comments and/or questions?

Dominican Sisters
of Mary Immaculate Province

Tỉnh Dòng ĐỨC MARIA VÔ NHIỄM

2025 Prayer Retreat Registration

RETREAT Links

Prayer Retreat Registration Form