Work Exchange

* These fields are required

1 Welcome

2 Choose the dates of your stay

3 Price

4 People in your group

Guest 1		First Name* Last Name* Email* Room Share Preference*
Guest 1		First Name* Last Name* Email* Room Share Preference*

After completing this form, emails will be sent to everyone in your group to complete their information.

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5 Participant Info

Email newsletter	Subscribe me to Hollyhock Talks emails!Enjoy special discounts, recipes, videos, podcasts, and blog posts from Hollyhock presenters and staff!
Phone *
Alternative Phone
Emergency Contact	Include name, relationship, and phone number of an emergency contact who will not be attending with you.
Catalogue Mailing List	Subscribe me to the catalogue mailing listWhen print material is available, we will deliver it to your doorstep!
Address
Address 2
City
State/Prov.
Zip/Postal
Country
Birth Date
Age *	under 18 18 - 24 25 - 39 40 - 54 55 - 64 65 - 74 75 +
What are your pronouns?	She / Her / Hers He / Him / His They / Them / Theirs Other Prefer not to say
Other Pronouns
We aim to create safer environments that cater to a diverse audience. Acknowledging the significant work being done in marginalized and racialized communities, our goal is to provide a platform for these voices to be heard. Please check all that apply:	Indigenous, Aboriginal, First Nations, Metis, or Inuit Black, or of African descent Person of colour White, Caucasian 2SLGBTQIA+ Person with a physical or cognitive impairment Person who is neurodivergent Recent immigrant or refugee Other
Room Share Preference *	Hollyhock's dorm accommodations use gender-based room assignment. Our mixed dorm is open to all genders. If you identify as trans, non-binary, neutral, or otherwise genderqueer and have selected a twin or 3-share room, please choose the shared arrangement that is most comfortable for you. You may call us if you have any questions or concerns. 1-800-933-6339
Requested Roommate	Please indicate the name(s) of anyone you would like to share a room with.
Meal Options *	We are returning to buffet service in 2025. All meals feature ingredients from our garden, locally sourced proteins, with a weekly oyster barbecue.
If you said 'yes' to Restricted Diet, please indicate which options apply to you:	Pescatarian Vegetarian Vegan Dairy Free Gluten Free We are a remote island location with limited resources. If you have any dietary needs outside what is offered here please contact registration@hollyhock.ca to ascertain whether we can accommodate your dietary requirements at Hollyhock.
If you clicked yes to "Life Threatening Allergy" please contact us directly to ascertain if we can accommodate your safety 1-800-933-6339. Please indicate your life threatening or serious food allergies here:
How did you hear about us or about your program? *	Online Search (e.g. Google) Program Presenter (e.g. presenter's website, email, podcast/interview) Hollyhock Email Social Media (e.g. Facebook, Instagram, Twitter) Retreat,Guru Marketplace Other Please select all that contributed to your decision to register today.
Are you bringing any children under 12 years old?	Yes
Please list their name(s) and age(s)
Are you age 65+?	Yes
Is this your second+ program this year?	Yes
Double Down 10% Discount	We will manually adjust your registration for 10% off tuition, and you will get a second confirmation e-mail once this is complete.
Please help us ensure your comfort by sharing any special information concerning accessibility requirements or other physical, emotional, behavioral, or relational needs.
Terms and Conditions *	I agree that my deposit is non-refundable and that the final balance will be automatically charged to the credit card on file 30 days before the eventFull terms & conditions can be found here.
Are you applying for a scholarship?
Why are you requesting financial support? *
What benefits do you hope to receive by attending this program, and how do you envision making the world better through that experience? You may also share any involvement you have in community engagement or volunteer work. *

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6 Donate

CAD $	Support Our Work Now is a time of tremendous opportunity for creating meaningful and lasting change in our lives and communities. Hollyhock supports emerging leaders through providing scholarships to diverse individuals who would not otherwise afford to attend our programs. Pay it forward and join us in inspiring and catalyzing those working towards a better world. Every bit counts. Thank you for your generosity.

1 Welcome

2 Choose the dates of your stay

3 Price

Select an option*

Volunteer

4 People in your group

5 Participant Info

6 Donate