Instructions:  Print this form and fill out all information as completely as possible.

Mail the completed form and required $100 retreat deposit to:
The Critter Basket Retreat
2275 Kale Blvd..
Fairfield, IA 52556

All registration forms must be complete and received by no later than four weeks prior to the retreat date listed.  Full payment for the retreat must be received by 2 weeks prior to the start of the retreat. Payment may be made via PayPal, check or money order, payable to The Critter Basket. Personal checks require ten days for clearing so please allow the extra time. Contact us for more information on how to pay using PayPal.     

Retreat Registration

Retreat Title __________________________________________________

Retreat Date __________________________________________________

Contact Name ________________________________________________________

   Family members attending:

 Name_________________________________ Age __________

 Name _________________________________ Age __________

 Name _________________________________ Age __________

 Name _________________________________ Age __________

(if more space is needed, please check here ______ and attach a second sheet)

Home Address ________________________________________

  _________________________________________

  _________________________________________

Accommodations:

________ Will bring own tent(s) [number & space needed, including area for poles and ropes]

                   _______ # tents      space needed  __________ feet x __________ feet

_________ Tent needed [circle one: 5 people     1 – 2 people    8 –10 people   ]

_________ Local motel information needed

Special Needs:

Please list any special needs, allergies, or dietary restrictions here.  While we will attempt to make accommodations for everyone, we will contact you if it simply isn’t possible to match your needs.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

NOTE:  If you have registered and are unable to attend, please give notice as soon as you know so that others may be given the opportunity to attend in your place. A refund will be issued upon timely notice.  Deposit is non-refundable.  No refunds will be given if cancellation is made within one week of retreat date as materials will have already been purchased. Materials may be mailed to you upon request at no extra charge, if you are unable to attend.

This web site owned and maintained by Sarah and Sean Johnson.  If you have any questions regarding this site, please feel free to contact us!