Nourishing You Moms Retreat 2026

Nourishing You Moms Retreat 2026 - CONFIRM

Congratulation on being selected for our 2026 Nourishing You Mom's Retreat from Wednesday, July 29th - Thursday July 30th. This form MUST be completed by June 25th in order to secure your registration. ** Please note this form is JUST for moms that were selected, please do not share this form with anyone.

First Name

Last Name

Phone Number

County (Example: Monroe, Onondaga, Exc)

Please Select One:

By checking the box below, I understand to reserve my spot, I am required to make a $25 payment that is non-refundable. (After completing this survey, you will be directed to our payment site. **This does not apply to guests attending on a scholarship.

YES I Understand

By checking the box below, I understand that if I register for this event and I am not able to attend, I must inform David's Refuge at least 1 week prior to the event. If I do not inform David's Refuge, I understand that my eligibility for future programs and services may be impacted.

YES I Understand

Participation in this wellness activity is voluntary and provided to you on an informational resource basis (regardless of the qualifications of the presenter). This activity or program is not meant to serve as professional wellness, medical or mental health or other advice. Any specific questions should be directed to your medical or other professional. By voluntarily participating, you accept and assume all risks associated with any exercises or techniques demonstrated or suggested and release the organizers, instructors, and facilitators from any and all claims, liabilities, or damages arising from your involvement.

By checking this box, you are certifying that you:

-are physically and mentally fit for participation in this program or activity and have not been advised otherwise by a qualified medical person.

-understand and are aware that participation in the Event involves risk, including, but not limited to, travel, physical activity, locales where public health and safety may be at risk, or activities that involve risk that is created for others or others may create for you.

-Understand that these risks may lead to a Loss, and you nonetheless choose to participate in the Event.

-Understand that there are risks that may not have been considered, yet waive my right to any claims that may occur from these unconsidered risks and I choose to participate in the Event.

-Acknowledge that no promises, representations, or affirmations of fact were made to me by David’s Refuge or its representatives concerning the safety or danger associated with traveling to the Event or participating in any activity or interaction related to or associated with the Event.

YES I Understand

Contact Information