Beginning Experience of Rochester, NY  -  Weekend Application
  Oct 5-7, 2018​ at Notre Dame Retreat House in Canandaigua, NY

Name______________________________________________ Circle One:  Male  Female

Address____________________________________________________________________

City____________________________________ State______  Zip Code_________________

Phone_______________________________      Cell Phone___________________________

Email_______________________________________________________________________

Date of Birth: ______/_______/________          Number of Years Married_________________

Separated Yes  No   How long?___________    Are you considering reconciliation?  Yes No

Divorced   Yes   No How Long?__________​      Widowed  Yes  No   How Long?_________

Number of Children___________    Ages______________________

Religion _____________________ Parish or Church _____________________________________

The Beginning Experience Weekend is appealing to me because ___________________________

 _______________________________________________________________________________

What do you hope to gain from the program? ___________________________________________

 _______________________________________________________________________________

Heard about BE from_______________________________________________________________

Physical or dietary limitations we should be aware of?______________________________________

Are you currently in counseling? _______________________________________________________

Signature _______________________________________________    Today's Date _____________

Note: If you are in therapy, you must have permission of your therapist to participate on the Weekend.  

Cost of the Weekend is $190.00 (includes meals & lodging).  Include a check for $50.00 as a deposit to 
reserve your spot.  Deposit is refundable when requested up to 7 days before the Weekend, balance due 
on or before the Weekend.  

You can pay a deposit by credit card at https://www.beginningexperience.org/weekend_registration.php 

Checks should be made out to: Beginning Experience of Rochester 

Mail to:  Beginning Experience of Rochester ~ PO Box 92248​ ~ Rochester, NY 14692

You will receive a confirmation of your application and deposit.

Any questions Please call (585) 987-1750 or email beofrochester@gmail.com




What to bring for your Weekend:
Notebook and pen              Comb/hairbrush                Slippers
Warm comfy clothes           Hair dryer                          Flashlight
Toiletries                             Curling iron                       Coffee mug AND travel beverage container
Toothbrush, toothpaste                   
Soap                                                                             Snack to share
Shampoo                                                                      Beverage to share

Weekend Application
Beginning Experience of Rochester NY
®

Serving the widowed, separated and divorced