queenswood sabbatical application

Printable Versions

To download a copy of this application form for Microsoft Word, click here. For a .pdf Adobe Reader version, click here.

Online Version

Contact Information

Name: *

Name of residence (if applicable):

Street address: *

City: *

Province/territory/state: *

Postal/zip code: *

Country: *

Phone number (including area code): *

Email address: *

Occupation/Ministry and Background

Occupation, academic work or ministry: *

Employer: *

Please describe your current occupation, academic work or ministry, as well as your hobbies and special interests: *

Please describe your past occupations, academic work and/or ministries: *

How would you describe your spirituality?: *

Please describe your goals and priorities while on sabbatical: *

References

Professional Reference

Name: *

Relationship: *

Daytime phone number (including area code): *

Personal Reference

Name: *

Relationship: *

Daytime phone number (including area code): *

Sabbatical Options

Bedroom type: *

Arrival Date: *

Departure Date: *

Add-on options:

I would like a Focus Session before or during my sabbatical (complimentary)

I would like to meet with a spiritual director during my sabbatical

I would like to meet with a counselor during my sabbatical

Please note that rates vary according to practitioner for spiritual direction and counseling. A Queenswood staff member will contact you to arrange further details such as dates and times

Dietary Requirements, Health and Safety

Please indicate any dietary requirement and health-related information that may affect your stay at Queenswood. Our restaurant can accommodate most diets with a healthy and well-balanced meal. If you are gluten intolerant, you are encouraged to bring your own bread and other staple foods, which can be stored in the restaurant fridge.

Dietary requirements:

Other:

Allergy(ies):

Other important medical information :

Emergency Contact

Please provide the name and telephone number of someone we can contact in the event of an emergency.

Name:

Relationship:

Daytime phone number (including area code):

Evening phone number (including area code):

Please Read

Sabbatical Cancellation
The first month's non-refundable payment must be received before your sabbatical registration can be confirmed. If a sabbatical registration is canceled after Queenswood has received the first month's non-refundable payment, we regret that we cannot issue a refund.

Liability
Queenswood is not responsible for any personal property that is lost, stolen, misplaced or damaged due to any circumstances beyond its control during your stay.

Respect for Retreat Environment
All retreatants and guests of Queenswood are expected to respect the quiet and peaceful nature of the retreat environment in all areas of Queenswood. Bedroom wings must remain silent at all times of the day and night. The Social Lounge and Dining Room are available for socializing, while the Library is available for quiet reading, work or relaxation. A Queenswood pin is available to all retreatants who wish to indicate to others that they are on silent retreat and do not wish to be greeted or engaged in conversation. All other retreatants are expected to respect wishes of silent retreatants.

Your Privacy
Queenswood respects your privacy and will not share any of your personal information with any third party organization. By supplying your email address, you will NOT be registered for any promotional emails, including Queenswood's e-newsletter. Contact information is recorded in order to contact you about your Personal Retreat only. If you would like to join Queenswood's e-newsletter, please click at the very bottom of this page.

By completing this registration form and submitting it, you agree to the preceding terms and conditions of retreats at Queenswood.

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

What code is in the image?: *

Copy the characters (respecting upper/lower case) from the image.

	Queenswood on Facebook
	Queenswood on Twitter
	Queenswood on YouTube
	Queenswood on Flickr
	Queenswood Blog