2019 OYFF Fall Retreat Registration Form
Stronger Together ~ Friday, September 20th - Sunday, September 22nd, 2019. Location northwestern Indiana.
Full Name (Last, First) *
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Email Address *
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Phone Number (Area Code/Number) *
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Street Address (Apt/Unit) *
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Street Address line 2
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City, State, Zip *
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Country
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Date of Birth *
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Have you attended a retreat in the past? *
If you have attended a retreat, please list the type of retreat(s) and the year(s) you have attended (traditional, veteran's, closed, adoptive mom/birthmom, mini-retreat)
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Type of Adoption *
Is the placement open, closed, semi-open? *
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Name(s)/DOB children placed *
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Date of placement(s) *
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Do you feel the placement was your choice? *
Are you parenting? *
If you are currently parenting other children, please list the name(s) and age(s) of your child(ren):
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What, if anything, made you decide to attend this retreat? *
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What do you hope to get out of this retreat? *
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What type of post-retreat support will you have? Please explain. *
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I am interested in: (please check all that apply)
Are you using/have you used illegal drugs within the past 6 months? (your answer will be kept confidential) *
Are you currently involved with any counseling or therapeutic services? *
If available, would you be interesting in pursuing a post-retreat counseling grant (in your area), for additional post-retreat support? *
Please list anything else you would like us to know for the retreat.
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