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About Us
Surrogacy in Canada
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Surrogate Mothers
Members
Resources
Contact

Registration Form for 2023 Retreat

Friday June 23 – Sunday June 25, 2023
Benmiller Inn & Spa
Benmiller, Ontario

Check-In Friday after 3pm
Check-Out Sunday at 11am

This event is FREE and includes accommodation and meals. Don’t forget your bathing suit! ***

Name(Required)

First Last

Partner's Name ** This also includes Support Person.

First & Last Last

Children (please list names with ages)

First

Current Status (at time of retreat):(Required)

First Name(s) of your Intended Parents (or Surrogate): (Past or Present)(Required)

Phone Number:(Required)

Alternate Phone Number:

Name of Emergency Contact & Relation to You (Spouse/Mother/Sibling, etc.)(Required)

Emergency Contact #(Required)

Email Address:(Required)

Please list any serious health issues you have (such as asthma, diabetes, allergies, etc.)...

Please list any food allergies, intolerances or special food requests...

Room Requests (special requests such river/pond views, other surrogates you'd like to be close to or if you require a fridge in your room). *** All Rooms have 1 King (or Queen) Bed comment below if you require room with sofa bed for child/children. ***

Are you okay with being photographed during the retreat? (Pictures will be shared on our website and social media).(Required)

Yes

No

How are you arriving at the retreat?(Required)

Driving myself

Carpooling

Not sure

How many nights will you be staying for?(Required)

Friday & Saturday Night

Friday Night Only

Saturday Night Only

Would you like to have henna with Sherri-Lyn? (*No Cost*)(Required)

Yes

No

Not sure?

Would you like to take part in a 20 minute session with Christine Crowley for a psychic reading? (*No Cost)(Required)

Yes

No

Not sure?

Would you like to take part in group yoga? (*No Cost)(Required)

Yes

No

Not sure?

Are you planning to book an appointment with Spa Services? (Bookings needs to be made in advance with Spa - Surrogates are responsible to cover cost). *** The Spa books quickly, email in advance to book your appointment to make sure you get a spot. To make reservations: spa@benmiller.ca A courtesy confirmation email will be sent regarding your appointment.(Required)

Yes

No

Not sure?

How would you like to spend your time at the retreat? (We will arrange our retreat itinerary based on majority preferences). Select all that apply...(Required)

Pool/Swimming

Spa

Yoga Class

Psychic Reading

Hiking/Walking (The inn is walking distance to the Falls Reserve Conservation Area. There is no charge for Benmiller Inn guests to walk into the park).

Painting

Henna

Visiting local area/towns/beaches (the town of Goderich is a 10 minute drive from the Inn).

Meeting other Surrogates

Time alone in my room/relaxing

Sleeping

Games

Movie Night

Meet & Greet Circle Time

PaintNite!!!

Other (please comment ideas!)

Other

Is there any other way that you would like to spend your time that has not been listed above?

I acknowledge and agree to the following...(Required)

1. If I am unable to attend the retreat I will make all effort to inform SCO immediately.

2. I will not bring in outside unregistered guests without the permission of SCO.

3. I will not bring excessive alcohol and/or illegal drugs to the retreat or Benmiller Inn property.

4. I will respect the guest rules of the Benmiller Inn.

5. I will be respectful towards SCO staff and members attending the retreat.

6. If I need to leave the retreat for any reason (such as an emergency) I will inform SCO as soon as I can.

I agree to the terms listed above.

Surrogate Signature:(Required)

Today's Date:(Required)

MM slash DD slash YYYY

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