REGISTRATION PRAYER COMPANION RETREAT

¨ Bonds of Friendship: Celebrating our Solidarity in the Jubilee year¨

To L’ARCHE Communities in Latin America, Canada and USA

Santo Domingo - Dominican Republic

August 20 -24, 2014

Please submit registration to: Azucena Bustamante-West y

Mirian Sunilda

Core Member – Personal Information

Name:
Male/ female
Telephone number:
e-mail:
Community:
First Language:
Second Language
Religious denomination:
Special needs (Please be very specific when stating your needs!)
Please check the appropriate box / SI / NO
The bedrooms are shared, please indicate if it is not possible to shared and need your own bedroom?
Can you use the stairs?
Do you need a shower chair?
Do you use a walker?
Do you use wheelchair
Is there any other information we should know about you?
Dietary Needs (Be specific!)
Food allergies:
Pureed food, if so, what do you need pureed?
Vegetarian:
Vegan:
Other:
If you require a plastic bed sheet, please bring your own. Thank you.
Has your community Leader approved this registration?

REGISTRATION PRAYER COMPANION RETREAT

¨ Bonds of Friendship: Celebrating our Solidarity in the Jubilee year¨

To L’ARCHE Communities in Latin America, Canada and USA

Santo Domingo - Dominican Republic

August 20 -24, 2014

Please submit registration to: Azucena Bustamante-West y

Mirian Sunilda

Assistant – Personal Information

Name:
Male/ female
Telephone number:
e-mail:
Community:
First Language:
Second Language
Religious denomination:
Special needs (Please be very specific when stating your needs!)
Please check the appropriate box / SI / NO
The bedrooms are shared, please indicate if it is not possible to shared and need your own bedroom?
Can you use the stairs?
Do you need a shower chair?
Do you use a walker?
Do you use wheelchair
Is there any other information we should know about you?
Dietary Needs (Be specific!)
Food allergies:
Pureed food, if so, what do you need pureed?
Vegetarian:
Vegan:
Other:
If you require a plastic bed sheet, please bring your own. Thank you.
Has your community Leader approved this registration?