Application - Resilient Retreat

Resilient Retreat began offering day programs in 2019 and overnight retreats in 2022.

To sign up for day programs or retreats, please complete the application below. A Resilient Retreat team member will call you to provide a brief screening over the phone to see if you qualify for services. If you are interested in signing up for the retreat, we will place you on a waitlist and require that you attend at least 5 day programs virtually or in-person before attending the retreat.

Once on the waitlist for the retreat, you will receive further communication and a specific application for retreats when you are nearing the date you are eligible to attend:

Program Application

Name*
First Last
Email*
Phone
Preferred method of contact
Is it safe to leave a voicemail on your phone?*
How would you classify your race/ethnicity?
What is your affirmed pronoun?
At Resilient Retreat, we serve two different groups of people (1. Survivors of abuse and 2. Professionals that witness trauma in the workplace). Please select the group(s) that apply to you (check all that apply):
- Survivor of abuse
- Professional that witnesses trauma in the workplace (e.g., advocates, counselors, EMS, fire fighters, frontline non-profit workers, police, teachers)
How did you hear about us?
I would like to learn more about the following programming:*
- Neurofeedback: 22 sessions
- Equine Therapy
- Workshops
- Support Groups
- Join the Waitlist for Retreats
As a child, were you ever placed in foster care?
Have you ever not had safe/secure housing?
Do you currently not have safe/secure housing?
Where do you live?
What is your zip code?
Would you like to sign up for our newsletter?*
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