A Jewish Adventure For Jewish Women of all ages

Sign up is as easy as...

1.

Circle the dates on your calendar! It's time for an adventure!

2.

Fill out the online Sign Up form. (Hey, shouldn't you be sharing this with your girlfriends??)

3.

Book your travel and you're on your way to a life-changing experience!

Let us know if you're on a special diet, need special accommodations, would like a payment plan or can use some help making travel plans. We're here to help! Contact our office at 718-604-0088 or email info @ baischana. org.

Women's Retreat May 31-June 3, 2026

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Page 1

Contact Information

First Name

Last Name

Cell Phone

Home Phone

Date of Birth (mm/dd/yyyy)

mm/dd/yyyy

Permanent Address

Street

City

U.S. State

Postal Code

Country

State/Province if outside of the United States

Page 2

Choose your room type:

We'll be staying in a group of beautiful homes in Paradise Village resort. Enjoy sprawling pools, fitness room, volleyball and pickleball fields, wifi, washer/dryers and serene desert views.

Rates are all inclusive, including your selected accommodations*, all classes, workshops and delicious Kosher meals, beginning with Monday night dinner and ending with a takeaway lunch on Thursday.

VIP Private - King Bed

Your own little sanctuary:
King size bed and private bath.

May 31-June 3 Rate ~~$1620~~ $1470

Girlfriend Getaway

Meet new people, make new connections: Queen and twin beds with loft beds, custom-built for grown-ups, with shared bathroom. For 3-6 women

May 31-June 3 Rate ~~$990~~ $930

Program only Program

(for anyone not sleeping over)

Join us for all classes, meals and workshops from dinner Monday night until departures and a pack-up lunch Thursday afternoon.

May 31-June 3 Rate ~~$720~~ $600

*Images represent a sampling of rooms. Actual rooms may vary in layout and decor.

No matter what you choose, each night of the retreat you'll decompress and relax surrounded by serene desert stillness, as you drift off into the deep sleep you know you need.

Select the type of accommodations you prefer

To share room with a specific friend or friends, please provide their name/s.

Share room 1

Share room 2

Share room 3

Page 3

Tell us about yourself

Relationship Status:
Relationships are such an important part of our lives. At Bais Chana you'll find answers to your most pressing relationship questions and dilemmas, and secrets that will strengthen even the best relationships!

Please explain.

What are you most looking forward to at the retreat?

What topics are you most interested in hearing about?

Have you ever attended a Jewish learning program or retreat? If so, please list when and what.

What do you hope to gain by attending?

Are you converting?

Who is your conversion Rabbi? (Please provide a name and contact information.)

Hebrew name, if known

Mother's Hebrew name, if known

Page 4

Important Information

Do you have any dietary needs or restrictions? Please be as specific as you can so we have what you need. If the answer is no, write no.

Do you have any allergies, including penicillin? If the answer is no, write no.

Significant medical history, if so, explain. If the answer is no, write no.

Will you be taking any medications when you're with us? If so, please list. If the answer is no, write no.

Emergency Contact Information

Contact Name

Phone

Relationship to You

Additional comments? Anything else you'd like us to know about you?

How did you hear about this retreat? Please check all that apply.

FriendFamilyFacebookOnline searchRabbi or RebbetzinOnline calendar listingSynagogue or Chabad HouseI'm a Bais Chana Alum!Other

Family/Friend Who Introduced you to Bais Chana

Referral First Name

Referral Last Name

Referral Phone

Referral Email

Add another referral name?

Yes, please

Ref 2 First Name

Ref 2 Last Name

Ref 2 Phone

Ref 2 Email

Please explain.

Media Permission

I give permission to Bais Chana Women International) to use photos, written quotes, audio or video of me in their promotional materials and for other non-profit purposes.

Page 5

Please choose your payment options below. Your registration is complete once you submit payment.

Accommodation Type

Choose your room type

PrivateGirlfriend GetawayProgram only (No Accommodations)

All rates are per person

Private Room Rates

Girlfriend Getaway Rates

Program Only Rates

Payment

Choose One Time Only to pay for your retreat in full now or choose Recurring to set up a payment plan. Select the number of months you need to pay off your balance -between 2 and 12. You will only be charged for today's installment. You will receive an email receipt with confirmation of each installment.

Payment Type

One Time OnlyRecurring

Installment Options

2 Months4 Months6 Months8 Months

Total Per Month

Please Donate!

Your kind donation will help another woman come! Thank you!

Donation Amount

Credit Card Information

Recurring Monthly Total

One Time Total

If you choose a payment plan (Recurring) this total reflects your full balance. Your card will only be charged for the first installment of your payment plan. The record of today's transaction amount will be in your email receipt.

Credit Card

Name on Card

Card Number

Code

Billing Email

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