Summer 2023 Retreat Registration Form

Full Name (First, Last)*

Home Street Address*

Home City and State*

What County are you From?*

Email Address*

Phone Number (Cell)*

Emergency Contact Name*

Emergency Contact Phone Number*

Please list any Food Allergies we should know about. (Please note that this is for MEDICAL ALLERGIES that if ingested will cause harm)*

Does the Allergy listed require medical attention if consumed or contacted?*

Do you have any Special Needs we would need to make accommodations for? (if none, list None)*

Requested Sewing Mates (Up to 3 Suggestions) If None, please respond None/Any. We will do our best to honor your request, but no guarantees.)

What Size Shirt do you wear/prefer?*

Do you plan to leave Retreat earlier than Sunday at Noon? Please list the day and time if you intend on leaving early.

Would you like to Schedule a Massage?*

If you chose Yes to a Massage, do you want a 15 or 30 minute Chair Massage? (30 mins scheduled if available - pay Masseuse directly in cash on the day of the event)*

Site Links

Contact Us

Amy's Quilt Room
20 West Penn Street,
Uniontown, PA 15401
Call us now: (724) 434-9987
Email: info@amysquiltroom.com
Click here for our store hours.

follow us

search our store

Summer 2023 Retreat Registration Form

Site Links

Contact Us