Registration - Step 1

Program Information

[% IF pr %] You are registering for a Personal Retreat.
$pr_dates [% IF outdoors %]

Outdoor housing only. [% END %] [% IF no_center_tents %]

Center tents are not available. [% END %]
[% ELSE %] You are registering for:
[% IF two_pics %] [% ELSIF one_pic %] [% END %]
Program:
$title
Dates:
$dates
[% IF leader_names %]
Presenter:
$leader_names
[% END %]
[% END %]
[% IF pr %] [% END %] [% IF basicfull %]
Length of Program

*How many days do you want to attend?

[% ELSE %] [% END %] [% IF covid_vax %]

Covid 19 Protocols

Masks: The Santa Cruz County Health Department recently reinstated an indoor mask mandate requiring face coverings for everyone regardless of vaccination status.

Covid 19 Vaccinations: Due to the current escalation ino cases of Covid-19 nationwide, we have determined the most responsible thing for the safety of all residents and guests is that everyone coming to MMC must be fully vaccinated.

Please take a picture of your vaccination card and upload it here:

*

[% END %]

Registrant Information

* Gender:



  6. Defaults to USA
  9. Repeated to be sure it is right
    10. [% IF ! housing_not_needed %]
  10. If you are driving to MMC.
    11. [% END %]
[% IF ceu %]

Continuing Education Credits

If you are a nurse[% IF mft %], LMFT, or LCSW[% END %] and wish to receive a CEU certificate

Like this: RN98765[% IF mft %], MFT43210 or LSW31415[% END %].
If you only want a certificate of completion enter COMP for the license #.
[% END %] [% IF staff_housing %]

Housing Choice

Due to our COVID protocols to assure adequate social distancing, the housing provided will be a bedroom with a private bathroom in the room or with access to private bathroom facilities.

If you have a physical disability that limits where you can be housed, please note this in “Additional Requests” below. [% END %] [% IF ! staff_housing && ! housing_not_needed %]

Housing Choice

$dncc_why
[% END %]
[% IF donation %]

Donation

$donation_msg $donation_input
[% ELSE %]

Gift Card

[% END %]

Preferences

[% IF ! pr && ! housing_not_needed %]

Carpooling

  2. Privacy Concerns?
[% END %]

How did you first hear about this program?

Shall we keep you informed of events at Mount Madonna Center?

[% IF kayakalpa %]
[% END %]

  1. Would you like to contribute to our Green Fund?

Green Funds will be used for sustainable innovations and eco-events at MMC.

Additional Requests

[% IF ! housing_not_needed %] [% IF ! pr || children_welcome %] Include the following in your additional requests: [% END %]
    [% IF ! pr %]
  • Arrival and/or departure dates if they differ from your program's. [% END %] [% IF children_welcome %]
  • The ages and names of children you are bringing, if any. Children under 2 are free; between the ages of 2 and 12 are half-price; age 13 and older, please register him/her separately, as an adult. [% END %]
[% END %]

Important Notes

    [% IF ! children_welcome && ! housing_not_needed %]
  • This program is for adults only - please do not bring your children. [% END %] [% IF ! collect_total %]
  • Balance is due on arrival (Visa, MasterCard, cash or check only).
    • [% END %]
  • $canpol
    • [% IF ! housing_not_needed %]
  • This form does not automatically reserve your spot for the program. [% IF ! collect_total %] You are not registered until we receive your deposit. [% END %] If the program is full, your deposit will be refunded.
  • Housing is not always available. Do not finalize your travel plans until you have received a housing confirmation from Mount Madonna Center.
  • We will be sending you a confirmation email. Don't let it end up in your spam folder. Add the following addresses to your list of acceptable emails: reservations@mountmadonna.org and notifications@mountmadonna.org.
    • [% END %]