Personal DetailsName* First Last Birthday* Date Format: DD dash MM dash YYYY Gender*MaleFemaleXMarital Status*SingleMarriedWidowedOtherReligious Denomination (i.e. Catholic, Anglican, United, etc.)*OccupationSpiritual Ministry (if applicable)Contact InformationAddress* Street Address Address Line 2 City State / Province / Region AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Postal Code / ZipContact Phone*Work PhoneEmail* Enter Email Confirm Email Is this a new address or phone number?*YesNoProgram DetailsPlease identify the program and date for which you are applying.Program Name*- select -Advent Taizé Weekend (2020/Nov/27 – Nov/29)CANCELLED - 8-Day Directed Retreat (2020/Aug/11 – Aug/19)CANCELLED - 8-Day Directed Retreat (2020/Aug/21 – Aug/29)CANCELLED - Exploring the Heart of Ignatius Spiritual Direction (2020/Nov/12 – Dec/08)CANCELLED - Getting Back to the Garden (2020/Aug/21 – Aug/29)CANCELLED - Ignatian Spirituality Retreat (2020/Oct/02 – Oct/07)CANCELLED - Ignatian Training Program in Spiritual Direction, Phase 1 (2020/Oct/01 – Dec/08)CANCELLED - Individual Retreats (2020/Oct/08 – Nov/03)CANCELLED - The Full Spiritual Exercises Experience - 40-Day (2020/Oct/01 – Nov/10)Directed Prayer Weekend (2020/Dec/04 – Dec/06)Incarnating Advent Retreat Weekend (2020/Dec/04 – Dec/06)VIRTUAL - 8-Day Directed Retreat (2020/Aug/21 – Aug/29)VIRTUAL - Teilhard Weekend Retreat (2020/Aug/14 – Aug/16)If the program is filled*Cancel my applicationPlace my name on a waiting listIndividual RetreatsIf applying for the Individual Retreats, please tell us your preferred start date & end date, and whether this retreat will be directed OR undirected.Individual Retreats - Preferred Start and End DateIndividual Retreats - TypeDirectedUndirectedFor VIRTUAL retreats, please indicate if you are available by Zoom or telephone. Zoom Telephone Spiritual DirectionIf you are attending a directed retreat, what qualities would you like in a spiritual director? (Please note that while we strive to meet your preference, we cannot guarantee this. If attending an undirected retreat, just note "not applicable")*What are your personal reasons for going on retreat? (Please choose all that apply.)* Silence & Prayer Ignatian spirituality Personal growth Rest and relaxation Inner healing Connect with the land Other If you chose "other" above, please add your reason(s) below.What types of retreats have you made? (Please choose all that apply.)* Silent Directed 8-Day This is my first retreat Have you made a retreat at Loyola House before?*YesNoHave you made the full Spiritual Exercises of St.Ignatius?*YesNoIf yes, please specify which one or both: 30-Day Annotation 19 Also, if yes, when and where?Additional InformationAt Loyola House, we strive to make your time here the best it can be.The Retreat House accommodations has two floors. Do you require the first floor due to mobility limitations? Yes No Please do tell us if you have food allergies. We cannot accommodate food preferences or dislikes. Celiac disease Lactose intolerance Nuts Vegetables Fruit If you entered "Nuts, Vegetables, and/or Fruit" above, please list:Are you Vegetarian Vegan Marketing InformationHow did you hear about Loyola House? (Please choose all that apply.) Family/Friend Community Spiritual Director Internet Advertisement Parish Bulletin Returning Retreatant ConfidentialityAll information received will be maintained in the strictest confidence and no data will be sold, distributed or in any other way communicated to individuals or organizations not directly related to Ignatius Jesuit Centre.PaymentAfter submitting your application below, payment instructions will be given to you with registration confirmation. We ask that you do not pay until then. Thank you.PhoneThis field is for validation purposes and should be left unchanged.