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Registration for "Thriving beyond Cancer" caregiver program

You qualify to attend this one-day program at Harmony Hill if:

  • You are a cancer caregiver
  • You are physically able to move between buildings and short distances

Priority will be given to those who have previously attended a cancer retreat at Harmony Hill; however, all cancer caregivers can apply and will be invited to participate based on space availability.

To register, submit the online form below to reserve your space. Questions? Contact Victrinia Ensor, victrinia@harmonyhill.org, or by phone at 1-360-898-2363 during business hours.
Yes! I want to attend the Caring for the Caregiver "Thriving beyond Cancer" program

*First name

*Last name

*E-mail address

*Postal address

*City

*State

*Zip

*Home phone

Work phone
Program you wish to attend:
Monday, May 5, 2008 - Caring for the Caregiver

Birthdate

Female

Male
*Have you ever attended a cancer program at Harmony Hill?
Yes No
If yes, list date(s) & program(s) you attended:
*How did you hear about this program?
*Briefly describe your current role as
a cancer caregiver
*How long have you been a caregiver for someone with cancer?
*How are you currently feeling physically & emotionally?

List any physical limitations you have that may require that you have assistance in order to participate in the program (such as dizziness or lightheadedness, shortness of breath, difficulty walking on uneven surfaces or stairs)

We serve balanced, primarily vegetarian meals with occasional fish. List any nutritional concerns our staff should be aware of (such as allergies, don't eat fish, dairy, wheat):
In case of emergency, please contact:

*Name

Relationship to you

*Address

*city-state

*Phone:

day

evening
cell