HWB 2025 "CONNECTION AND CARE" RETREAT - REGISTRATION FORM (v2)
(Please note that each person attending the retreat must complete this form. For example, a couple attending together must individually complete separate forms.)
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1. This retreat is specifically designed to support the wellness of Black people. The challenges and complexities of race as a construct, and labels for racial identities, are recognized. We deeply respect the diversity in the lived experiences and the intersectionalities of Black people. We are deeply committed to offering a safe space for Black people to heal-in-community. We ask that you respect this intention and only register for this retreat if you personally and sincerely identify racially as a Black person (of any ethnicity or nationality), or as a Black biracial person. Please confirm this below.

"By registering for this retreat I affirm that I identify racially as a Black person."
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Required

2. OUR 7 "HEALING WHILE BLACK" VALUES

Our retreat is grounded in a set of values that are fundamental to "Healing While Black". We believe that when we collectively and intentionally activate these values, our healing is optimized. We ask that you review them and indicate your support and intention to participate in co-creating a retreat environment that optimizes healing for everyone.

Healing is optimized in COMMUNITY and an Ubuntu consciousness, a recognition of our interconnectedness and that we belong to each other; the value of community requires creating an affirming environment of belonging that welcomes and embraces all of the diverse and intersectional expressions of our Blackness.

​Healing is fueled by LOVE, compassion, care; we give grace for our humanness, recognizing that we are all in different places in the process of evolving toward the highest expression of our highest individual and collective selves; we aim to circulate the energy of love in our interactions with each other and with the spaces we co-create- seeing with the eyes of love, listening with the ears of love, and acting from the ground of love.

​Healing happens within our AUTHENTICITY, when we can take of the “mask”, exhale, and be in the truth of who we are (without explanation, apology, or defense); healing happens when we can express ourselves fully and in spaces where we are seen and felt, accepted, and valued.

 For Black people, healing must include our LIBERATION and empowerment. Black health and wellness is a social justice issue given the role that anti-Black racism plays in our health, health risks, and health care.

 Healing is most effective when grounded in the CULTURE, reflecting and resonating with the collective “soul” of Black people.

Healing must include a HOLISTIC WELLNESS and integrative approach that attends to multiple dimensions of our well-being from the physical and emotional, to the relational and social, to the environmental and sociopolitical, to the cultural and spiritual.

​Healing makes space for JOY, for expressing our gifts, for fun and laughter, for awe. Healing is more than just surviving or getting some relief from pain and toxicity.

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3. First and Last Name *
4. Your gender pronouns (examples: she/her, he/his, they/their/them, etc.; for more information about pronouns click HERE)
5. Nickname or what you prefer to be called (optional).
6. Phone/Text Number  *
7. Your WhatsApp phone number (if you have one at this time). We will be using WhatsApp during the retreat for announcements and reminders.
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