Couples Healing Retreat

Couples Private Retreat Information Request Form

Spend a private (1 Couple Only) weekend retreat with Pastor Jack & Jhael Hakimian. Spend time at a South Florida Beach Hotel or Airbnb learning how to communicate, reconnect with God and each other. The couple's retreat is an investment into your marriage to reap results that money can't buy-Peace, Love, & Joy (Galatians 5:22)!

For Married or Enagaged Couples Only. No children, neighbors, or pets.
This form does not obligate you. You are only requesting more information from Jack and Jhael before making a decision.

Male First Name *

Same as the one you used to book your counseling session

Male Last Name *

Same as the one you used to book your counseling session

Male Primary Email *

You will receive a copy of this form. Check your spam folder too.

Male Phone *

Female First Name *

Same as the one you used to book your counseling session

Female Last Name *

Same as the one you used to book your counseling session

Female Primary Email *

You will receive a copy of this form. Check your spam folder too.

Female Phone *

When Would You Like To Take Your Private Retreat *

When and How Did You Meet *

What Are Your Challenges As A Couple *

How Does Your Family Feel About Your Relationship *

Male - Proffesional and Educational Background *

Female - Proffesional and Educational Background *

Male - Describe Your Relationship With God and Divine Purpose *

Female - Describe Your Relationship With God and Divine Purpose *

Upload Picture Of You Two (Children Too, If You Have Any) *

Drag and drop files here or Browse

File can be .jpg, .png, .gif, .pdf

Your Retreat Budget *

The budget includes travel, lodging, food, and payment for Hakimian's time. Think of this trip as a vacation.