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Birthparent Services

In-Person Spring Retreat Application | May 3-5

We are so happy you are interested in joining our retreat! Please fill out the application to the best of your ability. You will need to complete the "required" sections in order to submit the application. There are no right or wrong answers. If you have questions, please reach out to Vicki or Jennifer.

Please Note: This application should be completed by the prospective attendee. If you are completing this application on behalf of someone else, please indicate below.


First Name
Last Name

Personal Information

Please note, In order to be eligible to attend a retreat, you must have given birth to and placed a child for adoption.

First Name *
Last Name *
Country
Address Line 1 *
City *
State/Province *
Postal Code *
What are your pronouns?
Race/Ethnicity (Please check all that apply):
Are you eligible for Medicaid or Government Assistance?
What is the highest level of education you have completed?

Emergency Contact Information

Name
First Name *
Last Name *
Relationship
Phone #

Retreat Experience

Have you attended an On Your Feet Retreat before?
Traditional, Virtual, Veteran's, Closed/Reunion, Adoptive Mom/Birthmom, Mini-Retreat

Adoption History

Type of Adoption
How do you describe your placement?
Do you feel the placement was your choice?
Are you parenting?

Retreat Questions

Are you currently involved with any counseling or therapeutic services?
Are you interested in learning more about On Your Feet's Case Management services, including our counseling grants?

Medical Information, Communicable Disease/Covid-19, Allergies and Drug Use
Are you using/have you used illegal drugs within the past 6 months?
Your answers will be kept confidential.
Do you have a diagnosed condition (physical or mental) that may limit or impact your participation in an in-person retreat?
This information will not be considered for eligibility, but helps us to provide any needed accomodations in order to ensure the best experience for everyone.
Do you have any food allergies or restrictions that we should be aware of?
Communicable Disease/Covid-19 Policy and Agreement

On Your Feet Foundation has put in place preventative measures to reduce the spread of communicable diseases. However, we cannot guarantee that our retreat attendees will not become ill. To help reduce the risk of spreading an illness, please read and adhere to the following.

As a retreat attendee, I will comply with On Your Feet's Communicable Disease/Covid-19 Policy:

1. If I am experiencing any signs of a communicable disease, including any of the following symptoms within 48 hours of the retreat, I agree that I will not attend: cough, fever, chills, body aches, shortness of breath, loss of taste/smell, nausea/vomiting/diarrhea, stuffy/runny nose.

2. I certify that I will not attend the retreat if I test positive or if I have come into contact with someone who has tested positive for Covid-19 within 10 days prior to the start of the retreat.

3. I understand that it is in my best interest to stay home when in an infectious state to protect not only myself, but others at the retreat. Further, I understand that I will not be able to participate in the retreat in a meaningful way if sick. I understand that staying home helps prevent the spread of illness and will allow myself time to rest and recover.

If you have any questions or concerns, please reach out to Jennifer.

Communicable Disease/Covid-19 Policy and Agreement

Retreat Registration Information

**Please Read**

Thank you for taking the time to fill out our application! We are excited for you to learn more about our Birthmother Retreats.

We reserve a number of spots for first-time attendees. Once spots are filled, a wait-list will be started. If the spaces reserved for new attendees are not filled, the spaces will be offered to applicants who have previously attended retreats.

Registration closes 8 weeks prior to the start date of the retreat. On Your Feet will try their best to inform a “wait-listed” registrant one month prior to the retreat confirming whether or not she has a spot (to allow for budgeting, communicating with work, and to make transportation arrangements). If you are placed on the wait-list and do not get a space, you will be given priority to attend the next retreat.

If you are approved to attend the retreat, but have to cancel due to illness or exposure to someone who has tested positive for Covid-19, you will be given priority to attend the next in-person retreat. You will be eligible for a refund or a credit towards your next retreat.

The cost for an individual to attend a birthmother retreat is approximately $600. However, On Your Feet only asks attendees to pay a discounted rate of $100 (early bird pricing) or $125 (for registrations after the Early Bird Deadline has passed). We recommend planning in advance. This is a great way to take control of and prioritize your own well-being. If the discounted amount is unattainable, grants are available for applicants who demonstrate financial need. Applicants may also make arrangements with On Your Feet staff to set up third-party payments.

Transportation assistance (arranging carpools, help getting to/from train station and airports, etc.) is also available. Registrants are responsible for the cost of their transportation to/from retreats.


Registration Process

Retreat registration is a 5-step process. This helps On Your Feet plan retreats which optimize the attendees’ experience. This also ensures that all applicants will have sufficient support post-retreat.


Step 1: Read over the retreat details.

Step 2: Complete the retreat application.

Step 3: Submit payment. You have 2 options for payment. You can pay in full OR you can put down a deposit upon completing the application form and pay the remaining balance by the retreat date. Choose the option that works best for you!

Step 4: On Your Feet Foundation staff person will reach out to you within 3 business days of receiving your completed application and payment. Staff will discuss the agenda, what to pack, allow time for you to ask questions, and if necessary talk about our need-based grants to help cover retreat costs and assist with navigating transportation to and from the retreat, share check-in details and connect you with other retreat registrants or facilitators (if you wish!).

Step 5: After speaking with staff, you will be sent a retreat consent form and a Pre-Retreat Survey to complete. The survey helps us better tailor the retreat to meet everyone's needs.


One to two weeks prior to the start of the retreat, registrants will be emailed a welcome letter detailing the agenda, what to pack, directions to the retreat and contact information of the facilitators. Additionally, registrants can request to be connected to a retreat “buddy”; someone who has already attended a retreat, who will contact the registrant to answer any questions and give them a friendly face (or voice!) to greet them when they arrive for the weekend.

Remember, you must reserve your spot with a $25.00 non-refundable deposit.  Any registration received without a deposit will not be considered complete, unless you have also completed the application for a monetary grant.  If you have any questions or concerns about this, please contact Vicki or Jennifer.


RETREAT ATTENDANCE POLICY

On Your Feet retreats are a safe space for everyone involved - facilitators and participants. With that in mind, we ask that everyone attending the retreat please adhere to the following policies. Failure to do so may result in dismissal from the retreat at the attendee's own expense and/or ineligibility to attend future in-person events/retreats. 

1. Do not attend the retreat if you are sick. If you have been exposed to Covid-19, or any other communicable disease/virus within 14 days of an in-person retreat/event, you must have a negative test within 24 hours of attending. If you have a positive test or have symptoms including fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea, you will not be permitted to attend. If you develop symptoms during the retreat, you will be required to wear a KN95 mask and maintain social distancing for the remainder of the retreat.

2. This work is best done sober. Alcohol and drugs, without a valid prescription, are not permitted at the retreat. Please arrive at the retreat sober.

3. Weapons are not allowed. Weapons of any kind are forbidden on the retreat premises, including in vehicles parked on retreat property. There are no exceptions to this policy and anyone found in violation will be excluded from all future in-person events.

4. Know your rights. When traveling, please be mindful of state and federal laws regarding traveling with controlled substances and/or weapons. On Your Feet is not responsible for nor will the organization be able to provide assistance to anyone who violates state or federal laws. If you are detained for violation or suspicion of violation of any state or federal laws, you will not be eligible for reimbursement for the cost of the retreat or travel expenses.


I have read and understand the above section titled Retreat Registration Information, including the Retreat Attendance Policy. I agree to adhere to these policies.

Payment

Retreat Deposit and Payment

To secure your spot, we request that you pay a $25 deposit (this does not guarantee acceptance of your application, but secures your place while your application is reviewed). Once your spot has been confirmed, you will be notified by On Your Feet on how to pay the balance. If you have applied for a retreat grant, please wait until you have confirmation from one of our case managers regarding the total amount due. If you are interested in learning more about our need-based grant, please check the box below and a staff member will be in contact with you shortly.

I am interested in:
Please check all that apply.
Credit Card Information

cardholders
Your security code is the 3-digit code at the end of the signature field on your card's back.

Cover the fee associated with this online transaction?
Cover the fee associated with this online transaction?
Your total payment will be
Your credit balance will cover
Your credit card will be charged
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Payment Option
Retreat Payment

Thank you for recognizing the importance of post-placement support: