Online Registration – Living Waters Ministry

Have you attended a retreat at Living Waters before? *

Yes

No

How did you hear about the retreats at Living Waters? * How did you hear about the retreats at Living Waters?

Retreat/Class you wish to attend: *

Retreat/Class you are registering for:

Title *

First Name *

Last Name *

Address *

Address

City

State/Province

Zip/Postal

Country

Phone *

Email *

Date of Birth (MM/DD/YY) *

Age group *

If you are age 13-17, what is your parent/guardian's name?

Marital Status *

Emergency Contact *

Emergency Contact's Phone Number *

More About You (On-Site Retreats Only):

Please attach a recent photo of yourself for us to connect a face with the name as we are praying for you.

Maximum upload size: 314.57MB

Do you have food allergies? *

Yes

No

N/A

If yes, please describe your food allergies:

Do you have a medical issue that would prevent you from climbing stairs?

Yes

No

For us to better minister to you, please answer the following questions (On-Site Retreats Only):

Have you ever considered any type of self harm? *

Yes

No

N/A

Do you or have you ever had addiction(s)? *

Yes

No

N/A

If you answered "yes" to the above question, explain all addiction problems. Please note if they are past or current problems. If you answered "no" above, type "n/a" below: *

Are you presently receiving counseling? *

Yes

No

N/A

Please describe your reason for attending this retreat (reply N/A if not attending an on-site retreat): *

Please describe your background in reference to your relationship with God (reply N/A if not attending an on-site retreat): *

Have you had a major loss in the past year? *

Yes

No

N/A

If yes, please let us know in short detail about the loss:

Also, would you like to receive our monthly newsletter?

Yes

No

Online Class Questions:

Reason for Registering for the 10-week online Phase I HTH Class? *

Healing

Preparation for Advanced Training Certification

OtherOther

N/A

Church Affiliation (reply N/A if not registering for online classes)? *

Have you paid the $150 enrollment donation?

Yes

Not Yet

N/A