Section 1 of 1
"Discerning a Mission of Love" Registration Form
Sisters of Charity Federation | House of Charity, New Orleans, LA | September 1-4, 2023
A retreat for single, Catholic women interested in discerning religious life in the Charity charism!
A retreat for single, Catholic women interested in discerning religious life in the Charity charism!
Email
This form is collecting emails.Change settings
General Information
General Information
Loading...
Full Name
Full Name
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Date of Birth
Date of Birth
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Mobile Number
Mobile Number
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Address: Street, City, State, Zip
Address: Street, City, State, Zip
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Can we share your contact information with other participants on this retreat?
Can we share your contact information with other participants on this retreat?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Do you consent to having photos taken during the discernment weekend and used in Sisters of Charity Federation media?
Do you consent to having photos taken during the discernment weekend and used in Sisters of Charity Federation media?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
When and how did you learn about this retreat opportunity?
When and how did you learn about this retreat opportunity?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
What interests you in this experience? What are your hopes for this experience?
What interests you in this experience? What are your hopes for this experience?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Covid -19 Vaccination
Covid -19 Vaccination
We inquire about your Covid-19 vaccination status in order to help determine what precautions may need to be taken during our time together
Loading...
Have you received the Covid-19 vaccination?
Have you received the Covid-19 vaccination?
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
If received, are currently up to date? (in process with the primary series of the vaccine OR you have received at least one booster dose)
If received, are currently up to date? (in process with the primary series of the vaccine OR you have received at least one booster dose)
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Yes
No
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Emergency Contact
Emergency Contact
In case of any emergency of any kind, who should we contact?
Loading...
Full Name
Full Name
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Phone Number
Phone Number
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Relationship
Relationship
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Medical Information
Medical Information
Loading...
Please indicate any known allergies, including any medications
Please indicate any known allergies, including any medications
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Please indicate any special dietary needs or issues
Please indicate any special dietary needs or issues
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Please indicate any health conditions or other special needs of which we should be aware
Please indicate any health conditions or other special needs of which we should be aware
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Answer key
(0 points)
Loading...
Travel
Travel
Please plan to arrive by 4pm on Friday, September 1st. The retreat will conclude at mid-day Monday, September 4th. Therefore, please make flight arrangements or other travel plans to take place on 9/4 after 1pm.
Loading...
How do you anticipate traveling to New Orleans for the retreat? (We will reach out by email to get your specific travel information a few weeks before the retreat)
How do you anticipate traveling to New Orleans for the retreat? (We will reach out by email to get your specific travel information a few weeks before the retreat)
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
Travel by Flight
Travel by Car
Other…
Add option
…
Answer key
(0 points)
Loading...
Due to the generous support of the Sisters of Charity Federation, there is no cost to attend the retreat. However, we do ask participants to finance their own travel. If this will be a hardship for you, please indicate that you would like to seek a partial scholarship.
Due to the generous support of the Sisters of Charity Federation, there is no cost to attend the retreat. However, we do ask participants to finance their own travel. If this will be a hardship for you, please indicate that you would like to seek a partial scholarship.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Multiple choice grid
Checkbox grid
Date
Time
I will cover the cost of my travel.
I would like to explore the possibility of financial assistance to cover my travel.
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Link to Sheets
Message for respondents
This form is no longer accepting responses
Summary
Question
Individual
Insights
Total points distribution
Loading...
Settings
Responses
Manage how responses are collected and protected
Presentation
Manage how the form and responses are presented
Defaults
Form defaults
Settings applied to this form and new forms
Question defaults
Settings applied to all new questions