Resilient Voices Retreat 2021 Application:
Thank you for your interest in our Survivors' Retreat! Our retreat will be held September 23-26, 2021 near Asheville, NC.

This application is a quick way for us to get to know you and will also help us understand how we can help you get the most out of our retreat. The application questions are not meant to judge and there is no right or wrong way to answer them. They are simply an assessment tool that we will use to help us plan the best retreat possible.

Our 2021 retreat is for female-identifying sexual assault survivors, ages 18+.

Normally a retreat this size with so many offerings could cost well over $2000 per participant. Our specialty volunteers donate their time and expertise and receive no compensation for sharing their passion, gifts, and skills with us. So thanks to amazing donors and our volunteers, we are able to offer our retreat for a nominal fee of $375 if staying at the retreat center and $275 if commuting in each day or staying at a hotel. Beds at the retreat venue are first-come, first-serve but a local hotel will also be available for a discounted rate. The hotel accommodations are a separate cost and paid directly to the hotel.

If you are interested in participating in Equine Therapy with Horse Sense of the Carolinas, the cost will be an additional $75. Equine therapy will last approx 4 hrs. Check out https://www.horsesenseotc.com/ for more information about their organization.

The retreat cost helps cover 4 days/3 nights lodging in a beautiful and private location, healthy meals and snacks (including vegetarian options), insurance and liability, and transportation to/from the retreat center and the Asheville airport. Also included is expressive art therapy, trauma-informed yoga, sound healing, one-on-one photo empowerment sessions, and trauma workshops. There will also be bonfires and access to a hot tub and an unheated outdoor swimming pool. Participants will have time to journal, do art, and relax and will have safe areas where they can take breaks as needed. Overall, the weekend is bright, optimistic and looking towards healing and growth.

We invite you to join us for an amazing weekend of healing and fellowship with other survivors, all in a safe and nonjudgemental environment. You deserve healing and you deserve to find your Resilient Voice!



By applying, I understand that:

1. Completing this application does not guarantee acceptance to the Resilient Voices retreat. We have limited space but will make every opportunity to maximize attendees while maintaining safety and protecting the intimate group size that fosters friendships.

2. All participants 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 $375 ($275 if staying off-site). The donated services of the retreat are valued at $2500.

3. Despite all precautions, gatherings of any kind increase your risk of contracting illnesses, including COVID-19. Participants will need to abide by all social distancing and gathering rules applicable for North Carolina at the time of the retreat. Participants agree to follow all disinfection rules and not attend if they are ill and/or having symptoms of COVID-19. If a participant becomes ill during the retreat, they agree to be abide by isolation rules and agree to seek medical treatment as necessary.

4. This event is not considered medical or psychological treatment but rather an opportunity 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), 911, or go to your nearest hospital.

5. Participants are expected to maintain compliance with their medications, prescribed medical treatments, and therapy regimens, if applicable. Some of the activities and experiences at the retreat may be triggering and stressful and we understand that and will have outlets and support to assist you. There will also be plenty of opportunities for journaling and talking, as well as safe spaces to relax and decompress. But because this retreat is not medical treatment or therapy, and to ensure that all survivors have a safe and rewarding experience, participants must have basic coping skills and a basic ability to self-regulate their behaviors and emotions.

6. 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 may forfeit the acceptance status and spots may be made available to waitlist survivors.

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

8. Because of the limited capacity, once selected for the retreat, a nonrefundable deposit of $50 is required to hold your spot. A failure to pay the nonrefundable deposit may forfeit your acceptance and your spot may be offered to a waitlist survivor.

9. Applications are available beginning Thursday, April 1. All survivors will be notified about acceptance by Email. The $50 nonrefundable deposit is due after acceptance. The remaining $325 ($225 if staying offsite) is due by Friday, June 25. If participating in equine therapy, that additional $75 fee is also due Friday, June 25.

10. Refund Policy:
Payment can be made via PayPal, Venmo, or CashApp. Checks are also accepted. We will be able to do refunds on a percentage basis leading up to the retreat. The closer we get to the retreat, the harder it is to fill that spot which has been customized for lodging, transport, and meals. Please make sure you can attend before you commit. If you need to cancel, please let us know ASAP so that another survivor may have the opportunity to attend.

Please note the refund policy dates before committing:

Once retreat costs are paid in full, the following refund schedule applies (minus any nonrefundable PayPal/CashApp/Venmo Fees and nonrefundable $50 deposit):

90 percent refund June 26- July 2
80 percent refund July 3- July 9
70 percent refund July 10- July 16
60 percent refund July 17- July 23
50 percent refund July 24- July 30
40 percent refund July 31- August 6
30 percent refund August 7- August 13
20 percent refund August 14- August 20
10 percent refund August 21- August 27
No refunds after August 27

100% refund if the retreat is cancelled due to government/NC restrictions or requirements (if the state were to go to stay-at-home orders and prohibit any type of gatherings)
Email *
First and Last Name *
Confirm Email *
Contact Phone *
Date of Birth *
MM
/
DD
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YYYY
What is your assigned sex at birth? *
What is your gender identity? (transwomen and non-binary persons are welcome) *
What are your pronouns? *
How do you plan to get to the retreat location? *
What city and state will you be traveling from? *
Lodging (hotel costs are separate and you pay the hotel directly). *
Do you have any dietary considerations we should be aware of? *
Required
Are you interested in participating in Equine Therapy? (please note the additional $75 cost) *
Have you been, or are you currently in, therapy? *
Please Help Us Gauge Where You Are at in Your Healing Process with the PTSD Checklist
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 reminds 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; 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
Outlook Questionnaire
What do you hope to experience at the retreat and what do you hope to get out of it? *
Where do you hope to be 6 months after the retreat? (Approx. 250 words or less) *
Please share any progress you have made in your healing and any barriers you have encountered (Approx. 250 words or less) *
Additional Details You Wish to Share
Please check the boxes that you understand and agree to the following. Waivers and the code of conduct will be provided to you prior to the retreat: *
Required
Please share any comments or suggestions you might have for this retreat or future retreats:
How did you hear about us? *
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