Arrival: Thursday, @ 6:30 p.m.

Departure : Sunday, @ 3:00 p.m.

Many participants who have completed Module programming have indicated to us their interest to participate in Follow-up programming. These sessions are designed specifically around participant's current needs and formatted into the group model. Sessions are structured in the same way as module programming. Please reflect and provide in writing any current issues you would like to address.

If you are on any medication, prescription and/or non-prescription, please bring a sufficient supply in their original containers to last the duration of the retreat. Please note: Our village pharmacy and drug store has recently closed. Pleas ensure you bring any (for example) personal hygiene products, cough or headache remedies that you anticipate you may need.

Confirm your space in the Follow-up Session, by signing below. Fax or mail back a copy AS SOON AS POSSSIBLE AND AT LEAST TWO WEEKS PRIOR TO THE SESSION. (Registrations fill up quickly.)

We are looking forward to connecting with you. Thank you for your commitment and trust in BridgePoint to work with you in your healing journey.

I, (print)______________________________________, will be attending Follow-up programming and understand all previous information, i.e. referral, waivers, consents and guidelines agreed to in Module One remain in place for this programming. I also agree to inform BridgePoint of any changes in information.

X______________________________________________
Signature/Name

Phone Number : _________________________________

Email Address: _________________________________

Mailing Address, including Postal Code

______________________________________________________

Current Issues I would like to address are:

________________________________________________________________________________________

My expectations for this follow-up session are:

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Date: ______________________________ Name: (print) ______________________________________