"Spur" Love & Respect Marriage Retreat - Barren Heights Christian Retreat Center

Event: Cultivating Love & Respect Marriage Retreat
Date: February 15th – Feburary 16th
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. Come to hear personal stories of marriage failure, success, and adventure focused on spurring one another to love and good works.

$100 deposit required, refundable to those who have children with physical or developmental disabilities. If you are interested in attending, complete the application below!

Marriage Retreat Application

Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Husband's Full Name*
Husband's Date of Birth*
Date Format: MM slash DD slash YYYY
Husband's Email*
Husband's Phone Number*
Format: (xxx) xxx-xxxx
Husband's T-Shirt Size*
Husband's Food Restrictions (if any)*
Wife's Full Name*
Wife's Date of Birth*
Date Format: MM slash DD slash YYYY
Wife's Email
Wife's Phone Number*
Format: (xxx) xxx-xxxx
Wife's T-Shirt Size*
Wife's Food Restrictions (if any)*
Additional Information
How long have you been married?
Have you been married previously?
- Yes
- No
How is your Emotional Connectivity?*
How is your Physical Life?*
How is your Spiritual Life?*
How would you rate your ability to communicate?*
What is your primary love language?*
What is your spouse's primary love language?*
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?*
Do you have a child with a physical or developmental disability?*
- Yes
- No
Have you attended a Barren Heights retreat before?*
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 for training, promotion, and fundraising.
- I release Barren Heights, its directors, and volunteers, and the Community 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 Community Center is an alcohol, drug, and smoke-free environment. Use of cell phones is discouraged except when necessary.
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