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Yoga as Healing Retreat Registration
Thank you for your interest in this semester's Yoga as Healing Retreat! Please allot 15-20 minutes to complete this form.

Yoga as Healing is a trauma informed yoga program that offers participants a space to decolonize and reclaim healing practices in community. Each session offers participants a safe space to gain greater awareness around strength, stability, assertiveness, and mindfulness. Sessions will have different themes, focus on various restorative postures, build strength in the core, explore positive affirmations, and will be coupled with guided activities including de-briefing exercises. The retreat will allow participants to reconnect with themselves and build community with their peers.

The Yoga as Healing Retreat is intentioned to be a safe, affirming, and empowering, space for survivors of and those who have experienced gendered violence, including but not limited to: sexual harassment, dating and intimate partner violence, sexual assault, stalking, and sexual exploitation.

The retreat will take place the weekend of April 27th & 28th, 2019 from 9:30am-2:30pm each day in the Tilden Room (5th floor of MLK Student Union). Lunch, snacks, tea, water, yoga mats, and all other self care supplies will all be provided.

This form is due no later than April 19th, 2019. We will be conducting 30 minute intakes for interested participants, for which you will receive more information about following submission of this form.

Your information is kept completely confidential with the PATH to Care Center, whose mission is to provide confidential and affirming support to survivors. If for any reason, you would like to answer any part of this form (or the entire form itself) different way, please reach out to We are happy to provide alternative methods.

If you have any questions, comments, or thoughts please contact or 510-642-1988.

Email address *
Full Name *
first, middle, last
Pronouns *
ex: she/her, he/him, they/them
Phone Number *
Are there any identities you hold that you would like to share with us so we can better shape the program?
ex: sexual orientation, gender identity, ethnicity, im/migrant generation, class, documentation status, ability, etc.
Affiliation with Campus *
Do you have any dietary restrictions?
Can you commit to the entire retreat lasting April 27th & 28th 9:30AM - 2:30PM each day? *
Do you have any accessibility needs you would like to share with us?
Note: there may be use of essential oils.
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