Marriage Retreat

Date: February 17–18, 2024
Time: 9:00 a.m. CST (2/17) to 12:00 p.m. CST (2/18)
Location: Barren Heights Retreat Center
Address: 145 Yacht Club Rd., Scottsville, KY 42164

Join us for a marriage retreat hosted by our founders, Joe and Toni Rose, along with John & Lorie Weires, in partnership with Growing Your Marriage. Come to hear personal stories of marriage failure, success, and adventure focused on spurring one another to love and good works.

A $100 deposit is required to reserve your spot. This deposit is refundable to those who have children with physical or developmental disabilities. Contact kelly@barrenheights.org with any questions. NOTE: The Barren Heights Retreat Center is in Central Time, so all times listed are in CST.

Marriage Retreat Application

• Address*
  Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Husband's Full Name*
• Husband's Date of Birth*
  MM slash DD slash YYYY
• Husband's Email*
• Husband's Phone Number*
  Format: (xxx) xxx-xxxx
• Wife's Full Name*
• Wife's Date of Birth*
  MM slash DD slash YYYY
• Wife's Email
• Wife's Phone Number*
  Format: (xxx) xxx-xxxx
• Food Restrictions (if any)*
• Any physical limitations?*

• Additional Information

• How long have you been married?
• Have you been married previously?
  • Yes
  • No
• How is your Emotional Connectivity?*
  Very StrongStrongOkayWeakVery Weak
• How is your Physical Life?*
  Very StrongStrongOkayWeakVery Weak
• How is your Spiritual Life?*
  Very StrongStrongOkayWeakVery Weak
• How would you rate your ability to communicate?*
  Very StrongStrongOkayWeakVery Weak
• What is your primary love language?*
  Acts of ServiceQuality TimeWords of AffirmationGiving GiftsPhysical TouchNot Known
• What is your spouse's primary love language?*
  Acts of ServiceQuality TimeWords of AffirmationGiving GiftsPhysical TouchNot Known
• What 3 things do you enjoy doing with your spouse?*
• Briefly describe a core strength in your marriage.*
• Briefly describe an area that needs attention in your marriage.*
• What are your hopes and expectations for the weekend retreat?*
• How did you learn about Barren Heights?*
  Internet SearchSocial Media GroupTherapyFriend, family member, colleague, etc.Other
• Do you have a child with a physical or developmental disability?*
  • Yes
  • No
• Have you attended a Barren Heights retreat before?*
  Yes, I've been a guestYes, I've been a volunteerNo, I'm involved in other waysNo, I'm new to the community
• Email List Consent
  • I'd like to receive email updates from Barren Heights!

• All application information is kept confidential. Application information may be shared with retreat volunteers so they are better equipped to serve your family. This information will not be distributed or used for marketing purposes.

  Hold Harmless Agreement

  By checking the boxes below you are agreeing on behalf of your family to an electronic signature.

• Please check if you agree to the following statements.*
  • I give my consent that the information given at registration may be communicated with leaders and volunteers for the purpose of being equipped to provide the best care and assistance possible to my family.
  • I give my consent that photographs, interviews and audio/visual recordings during the course of the event may be used by Barren Heights and Growing Your Marriage for training, promotion, and fundraising.
  • I release Barren Heights and Growing Your Marriage, its directors, and volunteers, and the Retreat Center facility from all actions, damages, or personal injuries which may occur to me or a member of my family. I understand that in the event of a minor injury, I, or a member of my family may receive first aid treatment. I will be informed as soon as possible of any injury or condition of one of my family members and will be responsible thereafter for their care. In the event of an emergency, injury, or illness, emergency medical services and I will decide the best course of action. If the leaders are unable to reach me, I authorize them to take whatever action is necessary for the safety and health of my family members.
  • I understand that in order for everyone to experience a sense of calm, peaceful relaxation, the Retreat Center is an alcohol, drug, and smoke-free environment. Use of cell phones is discouraged except when necessary.
  • I hereby release and agree to hold Barren Heights, Harvest Heights and Growing Your Marriage harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss. I understand that this release discharges Barren Heights, Harvest Heights and Growing Your Marriage from any liability or claim that I, my heirs, or any personal representatives may have against them with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to any services rendered. This liability waiver and release extends to Barren Heights, Harvest Heights and Growing Your Marriage, together with all owners, partners, volunteers and employees.
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