Our Lady of Perpetual Help
Retreat and Spirituality Center

Diocese of Venice, FloridA

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Group Retreat Registration

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    Hosting a Group Retreat

Please select the desired Group Retreat and complete the form below
** Complete one form per Retreatant **
Retreat Cost includes Florida State Tax and fees
If you have any questions, please click here to send OLPH an email
Payments to OLPH are non-refundable.

Retreat Name	Date	Private Room	Shared Room	Commuter (No Room
Jubilee 2025 - A Path to Healing Your Broken Heart Fr Shawn Monahan, OMV	April 11-13	$385.00	$275.00	$195.00
Easter Triduum	April 17-20	$525.00	$360.00	N/A

The maximum number of form submissions has been reached. This form is currently not available.
- OLPH staff will review the registration form in strict confidence
- ----- RETREATANT INFORMATION -----
- Select the Group Retreat REQUIRED
  Please select the retreat date you are requesting
  Please fill out this field.
- Retreatant First Name REQUIRED Maximum 20 characters
  Please enter the first name of the Retreatant
  Please fill out this field. Please enter valid data.
- Retreatant Last Name REQUIRED Maximum 35 characters
  Please enter the last name of the Retreatant.
  Please fill out this field. Please enter valid data.
- Retreatant Street 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.
- Phone Number REQUIRED Maximum 20 characters
  Please enter the best phone number (including area code) to reach you
  Please fill out this field. Please enter a phone number.
- Email REQUIRED
  Please enter the email address to use for OLPH correspondence
  Please fill out this field. Please enter an email address.
- Date of Birth REQUIRED Maximum 8 characters
  Please enter your Date of Birth in MM/DD/YY format
  Please fill out this field. Please enter valid data.
- Are you Catholic? REQUIRED Yes No Please fill out this field.
- If you are of another faith, please specify: Maximum 60 characters Please enter valid data.
- Please identify if you are a member of a religious community
  If you are a member of a religious community, please select the following
- If you selected Other above, please specify: Maximum 60 characters Please enter valid data.
- ----- EMERGENCY CONTACT INFORMATION -----
- This information is to help us, as well as to provide EMT and health care professionals with important information in case of a medical emergency.
  Please note: EMTs are trained to ask questions about a person’s age, current medication, emergency contact numbers, and important medical history.
- Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Relationship REQUIRED Please fill out this field. Please enter valid data.
- Emergency Contact Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- ----- HEALTH INFORMATION -----
- OLPH is able to accommodate only the following special dietary needs:
  Celiac (Gluten-free); Lactose-free; Vegetarian
  We cannot accommodate Vegan requests
  Special Dietary Meals Surcharge: $25 per retreat
- (1) Please identify if you have any food allergies or medically-required dietary restrictions?
  Please note that OLPH is limited in its ability to accommodate special dietary needs; however, we will do our best.
- (2) Please identify any medical conditions or prescriptions that you would like us to be aware of that would help Emergency Health Care Workers treat you should you be unable to communicate with them.
- ROOM AND PAYMENT INFORMATION
- OLPH DOES NOT provide room-share matches.
  If you would like to share a room, YOU are responsible for identifying who you plan to share a room with and that person must also register seperately requesting a shared room and identifying you in question (9b) below
- (9a) Are you sharing a room with another registered Retreatant? REQUIRED
  Please note that OLPH does not provide room-share matches; you are responsible for identifying who you plan to share a room with and the person is registered. NO Room Shares offered for Ignatian Preached Retreat.
  Yes No Please fill out this field.
- (9b) If yes, please enter paid Retreatant's name Maximum 25 characters
  OLPH DOES NOT provide room-share matches; you are responsible for identifying who you plan to share a room with and the person is registered
  Please enter valid data.
- Selection REQUIRED
  Make your selection and press the Proceed to Payment button to complete your payment.
  Please fill out this field.
- Special Meal Surcharge REQUIRED Please fill out this field.
- Registration is not complete until you
  Proceed to Payment
Total:

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Group Retreat Registration

----- RETREATANT INFORMATION -----