APPLICATION FOR FEBRUARY RETREAT

Sign up for the retreat in 3 easy steps:

  1. Complete the application below.
  2. Submit and pay your $50 application fee. (Have a credit card ready.)
  3. If you’re applying for a Retreat Grant for yourself or a Childcare Grant, make sure to check that off on the application. You’ll receive an email with a short form to complete. If you’re not applying for a Grant, the cost for this retreat is $720.

Sign up for Single Moms Winter Retreat

February 2-5, 2017 -- Lake Arrowhead, CA


Application Fee: $50
Retreat Fee $720

Total cost: $770

Page 1
Personal Information















Please check your email for a link to the Grant application. 
Permanent Address







Family/Friend Who Introduced you to Bais Chana










Emergency Contact Information





Page 2




Children Information

John Doe - 6 - Male


John Doe - 6 - Male


John Doe - 6 - Male
If you’d like to share a room with a friend or friends, please provide their names and numbers below.




Page 3

Tell us about yourself




Page 4

Medical Information






Page 5

Thanks for completing the registration. We are so excited to see you soon!

Application Fee: $50
Retreat Fee $670

Total cost: $720

Please consider adding a donation to your $50 sign up fee. Every amount helps! You will be directed to the payment page once you submit this application.  Then click submit, review your responses and proceed to pay. 


If you checked off that you’ll be applying for a Grant, make sure to check your email for a link to the Grant application. We don’t ask for any financials, just your honest responses. 


See you soon!

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