Name *

First Name

Last Name

Cell *

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Please indicate the following as they apply to you *

I have an allergy. (Please clarify in notes below.)

I authorize Options to facilitate childcare for my child during this retreat.

I authorize photos or video taken during the retreat to be used by Options in publicities.

I suffer from (car) motion sickness.

I do not have a car seat.

I require special permissions to travel elsewhere in Quebec with my child.

I understand that by submitting this REGISTRATION form, I am commiting to attend this retreat. I understand that there is much planning and funding involved to ensure its success, and so I give my word that I will attend (aside from medical/family emergencies or requirements).

I understand and commit.