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Amarillo Retreat Registration

Thank you for your interest in attending a Mighty Waters retreat!

Mighty Waters retreats are designed exclusively for women who have been recently diagnosed with cancer, are currently undergoing treatment, or have completed treatment within the last 2-3 years. Our retreats provide a supportive environment offering therapies for the whole body, connection, and a chance for rest and renewal.

To ensure your safety and well-being, we now require a brief letter of medical clearance from a member of your care team (such as your oncologist, nurse practitioner, primary care provider) confirming that you are cleared to attend and participate in retreat activities. Before signing up, we encourage you to consult with your healthcare provider to ensure that the retreat activities are suitable for your current health and treatment plan. Their guidance helps us create the best experience tailored to your needs.

Please fill out the registration form below. Once submitted, you will receive a confirmation message, and a member of the Mighty Waters team will reach out to you.

Basic Information

Name: *

First

Last

Mobile Number: *

Email: *

Birthdate: *

Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Retreat Selection

Please select the retreat you are registering for: *

October 2-4, 2026

Do you need assistance with airfare transportation to attend the retreat? Mighty Waters partners with Angel Flight South Central to provide free flights for eligible attendees (limited availability). *

Yes, I am interested in learning more about this option.
No, I do not need airfare assistance.

If yes, please provide the nearest airport to your location.

T-shirt Size: *

Emergency Contact

Emergency Contact Name: *

Relationship: *

Phone Number: *

Demographic Information

Work Status:

Marital Status:

How many children 18 years or younger?

Cancer and Treatment Information

Is your cancer diagnosis or treatment completion date within the last 2-3 years?

Yes
No

Date of Cancer Diagnosis: *

Type of Cancer (including if metastatic): *

use please chair),

Please select the treatment you have received:

Surgery
Chemotherapy
Radiation

Treatment completion date:

If applicable, date of reconstruction surgery?

Medical Clearance Requirement

To ensure your safety and readiness for the retreat, we require that each participant provides documentation from a member of their treatment team (oncologist, nurse practitioner, primary care provider) confirming that you are medically cleared to attend and participate in retreat activities.

File Upload

Drag & Drop Files, Choose Files to Upload

Please upload a signed letter or form from your healthcare provider stating that you are medically cleared to attend the Mighty Waters Retreat.

I will provide my medical clearance letter at a later date.

I agree.

Health and Safety

Due to your treatment, are there any special sanitary or health precautions we should be aware of to ensure your safety and comfort during your stay? If yes, please list: *

Are you taking any medications related to cancer treatment or other conditions? If so, please list: (copy) *

Do you have any life-threatening allergies? If so, please list: *

Do you have any dietary restrictions (vegan, Vegetarian, Gluten-Free)? *

Please let us know if you use any mobility aids (such as a walker, wheelchair, or shower chair), have trouble getting up and down stairs, or have specific accessibility needs so we can make your stay as comfortable as possible. *

Recovery and Support

Are you facing any other physical or emotional health challenges? If so, please describe: *

What other challenges or major life events have you experienced during your recovery that are affecting you now? *

Retreat Goals and Requests

What goals/expectations do you have for the Mighty Waters retreat? *

Do you have any special requests or concerns?

Additional Information

How, or from whom, did you learn of Mighty Waters? Please be specific. *

Any other information you would like to include so that we may make your stay with us more comfortable?

Accommodation Agreement

To foster connection and community, accommodations are shared with one roommate. Private rooms are not currently available. *

I agree.
I do not agree.

Guest Signature *

Please note that typing your name in this box serves as an electronic signature.

Date *

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