Life Giving Wounds Retreat

Oct 3-5, 2025 | Registration for Life Giving Wounds Retreat, for Adult Children of Divorce.
Cost is $200, scholarships available.
This is a commuter retreat, and there is no onsite lodging.

Name

This address will receive a confirmation email

Phone

Address

Age

Please select all that apply.

18-22 23-29 30-39 40-49 50-59 60+

Religious Affiliation

Please select one option.

Catholic Protestant Unaffiliated Prefer Not to Say

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Email

If you live in the Diocese of Jefferson City, what is your parish/college? (If N/A, put your city and state.)

Parents' Marital Status

Please select one option.

Divorced Separated Married with High Conflict Declaration of Nullity (Annulment) Post Divorce Cohabitation Dissolution Never-Married

When did your parents divorce or separate? (Don't know? Put "Unsure" or N/A if not applicable.

How old were you?

Your Relationship Status

Please select one option.

Married Engaged Dating Single Divorced Annulled Consecrated Lay/Religious Priest Seminarian Novice Widow(er) Prefer Not to Say

Are any family members, a significant other, or friends attending this event with you? If yes, whom?

Have you discussed your family wounds with a counselor, priest, or trusted friend?

Please select all that apply.

Yes No

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? (If you are seeing a counselor or psychologist, then please consult first with him or her about whether he or she believes it is a good time for you to attend a retreat like this one.)

Please select all that apply.

Yes No

Do you have any food allergies the retreat team should be aware of?

Is there anything else you feel would be helpful to share with the team leadership at this time?

Payment

Pay in Full ($200.00) Request Scholarship (must contact Paul C.) ($0)

Amount

Credit/Debit Card Number

Expiration Date/CVC

Name on Card

Card Billing Address

Description

Oct 3-5, 2025

Registration for Life Giving Wounds Retreat, for Adult Children of Divorce.
Cost is $200, scholarships available.
This is a commuter retreat, and there is no onsite lodging.

Life Giving Wounds Retreat

Description

Please Fix the Following