2021 Healing Retreat for Survivors - Application Form
August 19 - 22, 2021 Bainbridge Island, WA
Name *
Gender Pronoun *
Email *
Phone Number *
What is your preferred method of contact? *
Where are you located? *
How did you hear about this retreat? *
What do you hope to receive from this retreat? *
What therapeutic/healing modalities have you already engaged for healing your childhood experiences? *
What are the support systems you currently have in place? *
What draws you to doing this healing work in a group? Have you participated in other group healing/emotional/spiritual experiences? *
Do you have any accessibility needs?
Do you have any food or dietary restrictions?
Is there anything else that would be important for us to know about you?
The cost for the retreat is a sliding scale of $300 - $900 which includes camping for 3 nights and nourishing organic meals. Please note that those who are able to afford payment at the higher levels help to make this retreat financially accessible to others. Which payment level would you like to register at? *
What payment method would you like to use? *
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