The Ministry for Adult Children of Divorce or Seperation Life-Giving Wounds Retreat will be held on Friday, June 10 until Sunday, June 12 at The Guggenheim Center, Saranac Lake. The registration fee is $100.00, which includes overnight accomidations, food and retreat materials. After clicking submit below, you will be forwarded to the $100 registration fee online payment. If you are in need of a scholarship please close out of the $100 online payment page after you hit submit and then contact Stephen Tartaglia at startaglia@rcdony.org or (315) 393-2920 ext. 1420. First Name(*) Invalid Input Last Name(*) Invalid Input Street Address(*) Invalid Input City(*) Invalid Input State(*) Invalid Input Zip Code(*) Invalid Input Date of Birth:(*) Invalid Input Phone Number:(*) Invalid Input Email Address(*) Invalid Input Religion:(*) Invalid Input Are you practicing your religion: YesNo Invalid Input Do you have any food allergies or any other allergies?(*) YesNo Invalid Input Please explain::(*) Invalid Input Parents relationship status:(*) Invalid Input How long ago did your parents separate/divorce:(*) Invalid Input How old were you:(*) Invalid Input Are there any annulments:(*) Invalid Input Your relationship status:(*) Invalid Input Are any family members, significant others, or close friends attending this event with you:(*) YesNo Invalid Input Whom:(*) Invalid Input Relationship to you:(*) Invalid Input Have you discussed your family wounds with a counselor, priest or trusted friend:(*) YesNo Invalid Input Do you feel emotionally and psychologically capable at this time to attend an event where strong emotional content about family life will be discussed, shared and processed:(*) YesNo Invalid Input If you are seeing a counselor or psychologist, please consult first with him or her about whether he or she believes it is a good idea for you to attend a retreat like this one. Thank you. How did you learn about this retreat: Invalid Input Is there anything else you feel would be helpful to share with the leadership team at this time: Invalid Input In case of an emergency, please contact: Emergency Contact Name:(*) Invalid Input Relationship to Retreatant:(*) Invalid Input Emergency Contact Phone Number:(*) Invalid Input The Diocese of Ogdensburg is committed to mitigating the risk of exposure to COVID-19. However, we cannot guarantee that you will not be exposed to it or any other pathogen. By participating in this event, I acknowledge the risk of exposure to communicable disease, and therefore agree to release the Roman Catholic Diocese of Ogdensburg New York of all liability for unintentional exposure or harm due to COVID-19. eSignature:(*) Invalid Input By eSigning my name above, I hereby affirm and certify that I understand and acknowledge the potential to be exposed to COVID-19 infection, and I will not hold the Roman Catholic Diocese of Ogdensburg New York liable. Submit function rsfp_runCondition706(){RSFormPro.Conditions.run({"form_id":"257","action":"show","block":"1","condition":"all","ComponentNames":["allergies explain"],"details":[{"operator":"is","value":"Yes","ComponentName":"Allergies"}]});}RSFormPro.Conditions.add(257, "Allergies", rsfp_runCondition706);function rsfp_runCondition707(){RSFormPro.Conditions.run({"form_id":"257","action":"show","block":"1","condition":"all","ComponentNames":["Whom","Relationship to you"],"details":[{"operator":"is","value":"Yes","ComponentName":"Attending with you"}]});}RSFormPro.Conditions.add(257, "Attending with you", rsfp_runCondition707);function rsfp_runAllConditions257(){rsfp_runCondition706();rsfp_runCondition707();};RSFormPro.Conditions.delayRun(257);RSFormPro.Conditions.addReset(257);