Name *

First Name

Last Name

Age Group *

18-25

26-35

36-45

46+

What areas of healing sound most appealing to you? *

Feel free to check all that apply.

Hiking/Outdoor Education

Nutrition Education/Cooking Classes

Art Therapy

Goal-Setting/Individual one-on-one work

Which statement below best describes you? *

Our retreats are faith-based, and we're a community of women who love Jesus. You absolutely do not have to be in relationship with Him to join us, but we want to be up front about some of the content we will be discussing during our time together.

I am a follower of Christ.

No, I am not a follower of Christ.

Faith is confusing to me in this season.

I'd like to learn more, but am not active in my faith.

I am currently practicing a different religion.

I don't consider myself religious.

Are you able to commit to a retreat, should you be selected? *

Sometimes, things happen and you can't make a retreat. We get it! However, not showing up for a retreat means you've taken a spot from another survivor who could benefit from our services. Should you be selected for a retreat, and you commit to coming to one, please know that we take attendance very seriously for the survivors on our retreat waitlist. Your deposit will not be refunded.

I understand.

I can't commit to plans in this season.