Cancer Program Interest Form | Harmony Hill Retreat Center on Hood Canal

Below is the online interest form to attend a Cancer Program workshop or extended retreat at Harmony Hill.

You qualify to attend the Harmony Hill Cancer Program if:

You have received a cancer diagnosis at any time in your life, and can provide your physician’s name and contact information. You are NOT required to be in active treatment or have an active cancer diagnosis to attend a retreat.
You are physically able to take care of your own personal needs, i.e., eating, bathing, walking (or operating a wheelchair or other supportive device).
You may only attend an Extended Cancer Retreat if you have not attended another Extended Cancer Retreat at Harmony Hill in the past 12 months. You may attend as many one day Cancer Program Workshops as you desire.

Retreats and workshops are filled on a first-come-first-serve basis. Those placed on waiting lists will be notified as space becomes available. Retreat/workshops participants may have one companion/support person attend with them for specified retreats only. If you wish to bring a companion/support person, please list their name when you complete the interest form below.

For extended retreat applicants: Please note that spaces can not be reserved until your full application(s) and deposits are received by mail or fax. Please click here for information about retreat deposits.

If you are having trouble with this form or have questions, please contact us at 360.898.2363 or programs@harmonyhill.org.

YES, I am interested in attending the Cancer Program at Harmony Hill Retreat Center!

* Required Information

Please mail me a retreat application form:

yes

Applicant First Name: *

Applicant Last Name: *

Companion First Name:

Companion Last Name:

Email: *

Mailing Address Line 1: *

Mailing Address Line 2:

City: *

State: *

ZIP Code: *

Main Phone: *

Secondary Phone:

List any special dietary needs you have:

Please let us know any physical restrictions you might have:

How did you hear about the Cancer Program at Harmony Hill?:

If registering for a one-day Cancer Program workshop, please indicate the dates of the workshop(s) you are interested in.

Date 1:

Date 2:

Date 3:

If registering for an Extended Cancer Program please indicate up to three dates that you are interested in attending.

Date 1:

Date 2:

Date 3:

* Email
* First Name
* Last Name
	* = Required Field