Cancer Retreats - for those facing cancer


About	Facilities	Calendar	Programs	Ways to Give	Contact Info

Registration for 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.

Yes! I want to attend a caregiver program at Harmony Hill To register, submit the online form below to reserve your space.

Questions? Please contact Victrinia Ensor, victrinia@harmonyhill.org, or by phone at 1-360-898-2363 during business hours.

*Signifies required information

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*First Name

*Last Name

*E-mail Address

*Mailing Address

*City

*State *Zip

*Home Phone

Work Phone

Program you wish to attend:

March 8, 2010 - Caring for the Caregiver

April 23-25, 2010 - Cancer Caregiver's Retreat


*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?
Your Birthdate	Check One FemaleMale

*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/Zip

*Day Phone

Evening Phone

Cell Phone