Sunlight Retreats LLC: August Sunlight Retreat Fellowship Application
The 3rd Sunlight Retreat for Survivors will be a four day weekend retreat held near San Diego, about 30 minutes from the San Diego Airport. We will be a in a private ranch home with a full kitchen, private bathrooms and showers, open air space, fire pit, porch, unheated pool and large lawn. Participants will have time to journal, and safe areas to go if they would like a break from the discussions, which may be difficult at times. Overall, the weekend is bright, optimistic and looking towards healing and growth. The retreat will take place August 22-25th, 2019 in San Diego, CA. Feel free to see detailed descriptions of our past two retreats on our blog on www.sunlightretreats.org.

By applying, I understand that:

1. Completing this application dues not guarantee acceptance to the Sunlight Retreat, we have limited space but will make every opportunity to maximize attendees while protecting the intimate group size that fosters friendships.

2. All guests will be required to sign a liability waiver, and will only pay the at-cost rate it takes to host the retreat and cover food, insurance, the venue and hard costs, which is $300. The donated services of the retreat is valued at $2500.

3. We have some excellent resources that will be volunteering their time. Please note this event is not considered medical treatment but rather to provide social support and information. It is not intended to diagnose or treat any medical or psychological condition. Please consult your healthcare provider for individual advice regarding your own situation. If you need immediate care please call 800.656.HOPE (4673) or go to your nearest hospital. The retreat is open to female (transwomen and non-binary persons are welcome) survivors (ages 18+).

4. Participants must complete all waivers and copays by the assigned dates outlined in emails in order to retain their spot at the retreat, an incomplete packet by the required registration deadline will forfeit the fellowship acceptance status and spots will be made available to waitlist survivors.

5. Communication efforts are primarily through email and at times through phone, if needed. It is imperative that the survivor has regular email access. Thank you!

First Name *
Your answer
Last Name *
Your answer
Email *
Your answer
Confirm Email
Your answer
Contact Phone *
Your answer
Age (We welcome all ages over age 18)
Your answer
Occupation
Your answer
Do you have health insurance and access to care? (We welcome those with or without care)
Diversity and Inclusion: Please share any that apply
Please Help Us Gauge Where You Are at in Your Healing Process with the PTSD Checklist and Change Questionnaire
Repeated, disturbing, and unwanted memories of the stressful experience?
Not At All
Extremely
Repeated, disturbing dreams of the stressful experience?
Not At All
Extremely
Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?
Not At All
Extremely
Feeling very upset when something reminded you of the stressful experience?
Not At All
Extremely
Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?
Not At All
Extremely
Avoiding memories, thoughts, or feelings related to the stressful experience?
Not At All
Extremely
Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?
Not At All
Extremely
Trouble remembering important parts of the stressful experience?
Not At All
Extremely
Having strong negative beliefs about yourself, other people,or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me,no one can be trusted, the world is completely dangerous)?
Not At All
Extremely
Blaming yourself or someone else for the stressful experience or what happened after it?
Not At All
Extremely
Having strong negative feelings such as fear, horror, anger, guilt, or shame?
Not At All
Extremely
Loss of interest in activities that you used to enjoy?
Not At All
Extremely
Feeling distant or cut off from other people?
Not At All
Extremely
Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?
Not At All
Extremely
Irritable behavior, angry outbursts, or acting aggressively?
Not At All
Extremely
Taking too many risks or doing things that could cause you harm?
Not At All
Extremely
Being “super alert” or watchful or on guard?
Not At All
Extremely
Feeling jumpy or easily startled?
Not At All
Extremely
Having difficulty concentrating?
Not At All
Extremely
Trouble falling or staying asleep?
Not At All
Extremely
Change Questionnaire: Please rate your feelings towards the following statements
I want to make this change *
Definitely Not
Definitely
I could make this change *
Definitely Not
Definitely
There are good reasons for me to make this change *
Definitely Not
Definitely
I have to make this change *
Definitely Not
Definitely
I intend to make this change *
Definitely Not
Definitely
I am trying to make this change *
Definitely Not
Definitely
Please check any boxes that seem relevant to your attack so that we might be able to better focus sessions and discussions. This is not for judgement and will remain private.
Please share any progress you have made in your healing and any barriers you have encountered (Approx. 250 words or less) *
Your answer
Where do you hope to be 6 months after the retreat? (Approx. 250 words or less) *
Your answer
Retreat Customization
Travel Logistics *
What city would you be coming from? *
Your answer
Food Restrictions: We will do our best to accommodate any food preferences *
Lodging and Costs *
Do you plan on attending the retreat with a fellow survivor friend? If so, please mention their name for lodging assignments. (Most survivors do not come with friend, but friends are welcome- whatever makes you comfortable!)
Your answer
Do you plan to do the optional yoga? *
I am interested in doing a Self-Defense empowerment session *
Not At All
Very
I am interested in doing a one on one NET Stress Reduction *
Not At All
Very
I am interested in doing acupuncture *
Not At All
Very
I am interested in service animal visits *
Not At All
Very
I am interested in healthy cooking demo for PTSD, Anxiety and Depression *
Not At All
Very
I am interested in Art Therapy *
Not At All
Very
I am interested in staying in touch with my Team 3 Survivors after the retreat *
Not At All
Very
Please share any comments or suggestions you might have for this retreat or future retreats: *
Your answer
Is there anything you would like to share that might help us make you more comfortable?
Your answer
Emergency Contact/Safe Person Name and Phone: *
Your answer
How did you hear about Sunlight Retreats? *
Your answer
Please check the box that you understand and agree to the following. Waivers and the code of conduct will be provided to you upon registration: *
Required
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