Adoption Healing...                       

40 years of helping those whose lives have have been touched by adoption

Healing Weekend Registration        

*** Please do not make airline reservations until we confirm your weekend.           SiteLock

If you are paying by Credit Card, the address you give must be the address at which you receive your Credit Card Bill.

(Keep in mind that the purpose of the healing weekend is to focus on healing the wounds caused by the separation
of mother and child and to provide tools to enable you to continue your healing from this trauma at home.
   *  = Required
 *  Salutation   Mr.    Mrs.     Ms.                         First:                           Last:
  Street 1:                                              Street 2 :
 * City:       State/Province             Zip:     * Country:
  Home Telephone.:     Business Telephone.:     * I am Adoptee     Natural Parent
 * E-mail:  *     Confirm  E-mail:
 * Emergency Contact:    * Relationship to you       *Phone      
     Facebook name:    Facebook URL   
 *  Have you been in therapy for adoption issues?     If so, for how long ?       Your age ? 
* Borrow a sleeping bag ?    Do you have a car?   * Food Requirements:
*   By placing an 'X' in the box to the left, I agree to provide proof of my full Covid-19 vaccination via email or fax to complete my registration.
*   By placing an 'X' in the box to the left, I agree to attend Chat on a regular basis or if i cannot, then i will attend a free on line information session.
*   By placing an 'X' in the box to the left, I acknowledge that there are cats at the weekend. I agree to bring my own allergy medicine if I am allergic.Target.
*   By placing an 'X' in the box to the left, I agree to bring my own towels...
*   By placing an 'X' in the box to the left, I agree to wait until my weekend is confirmed to make my travel arrangements and I assume all responsibility for my travel costs.
*   By placing an 'X' in the box to the left, I  agree to the following 2 items:  1.)  I understand and agree that the fees for these weekends are non-refundable.  2.)   If a replacement for my spot is found, a $75 cancellation fee will be charged and the remainder of the  fee that I paid  will be applied to a future weekend.. else the fee is forfeited.
We suggest you take out travel insurance to protect yourself in case you are unable to attend.

 *   Healing Weekend $250 USD (Non-Refundable)                                        $150 deposit required

      Reunited Pairs Weekend $300 USD (Non-Refundable)                            $150 deposit required  

Date of Weekend          Your balance is due four weeks prior to your weekend

Payment Information           

Payment Amount        Pay by      Name on Card  
Card Number    Card Expires        Security Code  What is the security code?
                      If you are Not paying by credit card, enter 00 in the Security Code Box above.

Please press the SUBMIT button below

Signature _______________________________________        Date ________________

You may also make your payment by faxing your Name and Credit Card info to: 845-267-2736,
S  or you may send the payment via US Mail

Adoption Healing,
74 Lakewood Drive  Congers, NY 10920-1710

If paying by check, make the check out to Adoption Healing.

   E-mail us at joesoll@adoptionhealing.commailboxFormMail  

Last Updated on April 1, 2011 by Joe Soll                         Copyright 2011 Adoption Healing all rights reserved; logo's and graphics appearing on these pages are trademarks of Adoption Healing and may not be used or reproduced without permission.