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Marymount Hermitage

2150 Hermitage Lane    Mesa, ID 83643-5005
Phone: (208) 256-4354 (Message only)

 

 

APPLICANTS for solitary free retreats for priests are kindly asked to complete this form. The information will be kept strictly confidential. Please sign your name under the photograph. Thank you very much.

 

Name:

ATTACH RECENT PHOTO HERE

Address:

 

City, ST Zip:

 

Phone:

 

Email:

 

Circle preferred title: Rev.   Fr.    Dr.  Other:

 

Date of birth (mm/dd/yy):

 

Religion:

Date of Ordination:

Parish (if applicable):

 

Ordained for:

Current assignment (if other than a parish)

 

Phone number of the Diocesan Pastoral Center where you live:

 

 

RELIGIOUS or MEMBERS of a SECULAR INSTITUTE:

 

TITLE of CONGREGATION:

 

COMMUNITY INITIALS:

 

SUPERIOR’S NAME:

 

Type of Superior (Circle one):

Local, Provincial, or Superior General

Address:

 

City, ST Zip:

 

Phone:

 

 

RETREAT EXPERIENCES: (Check appropriate boxes)

 

 

None

Once

Several times

Many times

Preached Retreat(s)

 

 

 

 

Directed Retreat(s)

 

 

 

 

30-day Directed Retreat(s)

 

 

 

 

Solitary Retreat(s)

 

 

 

 

Other (specify):

 

 

 

 

 

 

 

How did you first hear of Marymount Hermitage?

 

 

Why do you want to spend time in solitude here?

 

 

What time would you prefer to offer daily Mass?

 

Would you be willing to offer Mass at the scheduled time according to the Sisters’ published seasonal schedule?__________

 

Outline in some detail how you plan to organize your day in solitude (use reverse side for more space)

 

 

What do you plan to do for exercise?

 

Opportunities for manual work are primarily for the benefit of the retreatant although it contributes to maintaining the buildings and grounds of the Hermitage.

 

If you are interested in doing solitary work while here, please check your preferences.

 

INSIDE

OUTSIDE

Light Work

 

 

Moderate Work

 

 

Heavy Work

 

 

 

Also please state the hours per day and days of the week that you plan to work:

 

Describe your present state of health:

Mention any health factors which could possibly affect you while at Marymount Hermitage in solitude (e.g.) handicap, illness, recent surgery, allergies, medication, recent trauma, major life change, death of a loved one, etc.:

CONTACT PERSON: In the unlikely event of a medical or other emergency, please give the name, address and phone of someone whom we may contact in your regard. You may give more than one contact person (list additional on reverse side). Also give a general description of your relationship to this person (e.g.) pastor, friend,  religious superior:

 

Name:

 

Address:

 

City, ST Zip:

 

Phone:

 

Relationship:

 

 

RECOMMENDATIONS: Please list below the names and addresses of TWO people WHOM WE MAY CONTACT for letters of recommendation for you. They should know you well enough to answer questions regarding your ability to profit by a period of solitude. As a courtesy, you might ask them beforehand if they are willing to write back to us when we contact them.

 

Name #1:

 

Address:

 

City, ST Zip:

 

Name #2:

 

Address:

 

City, ST Zip:

 

GUIDELINES:

 

Yes

No

Do You smoke?

 

 

Do you intend to bring a tape or cd recorder/player?

 

 

Do you intend to request informal spiritual sharing with one of the Hermit Sisters?

 

 

FOOD: We request that you bring (or purchase locally) whatever food you will need for your meals while at Marymount. Some staples are furnished: salt, pepper, sugar, tea, coffee and some canned and packaged foods.

 

Yes

No

Are you able and willing to cook your own meals in your hermitage?

 

 

 

 

 

 

 

 

 

 

 

RESERVATION: Please specify Primary and alternative Dates

 

Starting

Ending

Primary Dates Requested (mm/dd/yy)

 

 

Alternative Dates Requested (mm/dd/yy)

 

 

 

DEPOSIT POLICY: A non-refundable deposit of $50 must accompany this completed application form. If you change your retreat date or cancel, the deposit is still non-refundable.

TRANSPORTATION: Please complete the information sheet (which can be printed off the internet) when your retreat reservation is confirmed in writing and your travel plans have been completed.

 

Please send this application form with your deposit to: Marymount Hermitage at the address listed on the top of this form. Make check out to "Marymount Hermitage".

 

Thank you sincerely and God Bless you.