Taste of the BayNVC Leadership Program (LP) Retreat and Youth Program Questionnaire
Please respond to the questions below. We need one questionnaire response per participant. So if you are registering for yourself and for another person/other people (such as your child/children and/or spouse or partner), please ask that person/people to respond to this questionnaire as well.
Basic Information
Your full name (as you would like it on your name badge)? *
Your answer
Your email address *
Your answer
Your phone number *
Your answer
Your mailing address *
Your answer
Emergency contact information (name and contact information of who we should contact in the event of an emergency) *
Your answer
Are you a BayNVC LP (Leadership Program) alumnus? *
Leading up to the retreat the BayNVC LP alumni will have an opportunity to extend their learning through a series of four tele-classes facilitated by Roxy Manning and Mireille Van Bremen. Roxy and Mireille will guide the alumni to develop their own NVC training sessions to be offered at the retreat. Alumni participating in this enhanced learning opportunity will also participate in feedback sessions on these offerings during the retreat. So if you are a BayNVC LP alumnus, will you want to participate on these tele-classes and develop your own NVC training session/s to be offered at the retreat?
In what age group are you? *
People ages 16 and 17 will have a choice of participating in the adult program or the youth program. If you will be age 16 or 17 on June 17 (the first day of the retreat), in which program will you want to participate?
Are you attending the retreat with a family member/s? If so please indicate their name/s and their relationship/s to you. If the person/people is/are 11 years old or younger, please also indicate their age/s. (If you are not attending the retreat with a family member just write "no" in the space below.) *
Your answer
Meal Selections and Lodging
Dietary Preference *
Allergies? - we will accommodate these restrictions *
No restriction
Food restriction
Serious allergy
Dairy
Gluten
Nuts
Shell fish
Other food restrictions/allergies? Please specify how serious it is (e.g., how concerned should the chef be of cross-contamination). You may need to bring your own food to supplement what we can offer.
Your answer
What level of lodging are you requested? *
Do you want to be assigned to the same room with anyone else? If yes, please put the other person's name or other people's names here.
Your answer
Linens and toiletries will not be provided by the venue. This means that as a group we are collectively responsible for everyone in the group having bedding (sheets, blankets, sleeping bags, pillows and pillowcases) and towels, soap, shampoo, and other toiletries. Please respond below accordingly. *
Required
If you checked "Other" in response to the question above, please elaborate below.
Your answer
Are you willing to bring bedding for another person or other people? *
Required
If you checked "Other" in response to the question above, please elaborate below.
Your answer
Please also note that the sleeping rooms will not be locked, so please do not bring valuables with you. *
Required
Any accessibility needs? We may not be able to accommodate them, but we will be in touch with you.
Your answer
Transportation Requests
Can you offer a ride to the retreat? If yes, from where can you pick up passengers (choose more than one, if possible)? *
Required
If you checked "Other" above, from where can you pick people up?
Your answer
If you answered that you can offer a ride to the retreat, how many passengers can you bring?
Your answer
Do you need a ride to the retreat? If yes, from where would you like to be picked up? We may ask you to take public transportation to an accessible meeting place. *
Required
If you checked "Other" above, from where do you need a ride?
Your answer
Please plan your travel in a way that takes into account the LP Retreat schedule on the first evening (June 17) and the last morning/afternoon (June 24). Dinner will be provided on the first day at 6:00 PM. Opening circle will be at 7:15 PM. Please arrive on June 17 after 3:00 PM and before 7:00 PM; or by dinnertime if you want dinner. Breakfast will be provided at 8:00 AM and lunch will be provided at 12:00 PM on June 24, the last day of the retreat. Our group will need to be fully departed from the grounds by 2:00 PM on June 24. Please type below to say what time you plan to arrive on the first day, and what time you plan to depart on the last day? (If you're not sure yet, just type "I don't know yet" below.) *
Your answer
If you do need a ride, and you're going to be flying, please indicate your flight information below including your airline (if you have that information already).
Your answer
Is there something you'd like to contribute?
Any other comments, requests, or concerns?
Your answer
Thank you! Once you click the "Submit" button below someone will follow-up with you by phone and/or email to welcome you and so you can make payment and complete your registration. Please note that it could take a day or two before you are contacted.
Submit
Never submit passwords through Google Forms.
This form was created inside of Bay Area Nonviolent Communication. Report Abuse - Terms of Service - Additional Terms