On Your Feet Birthmom Retreat Application

On Your Feet Retreat Application | Part 1

We are so happy you are interested in joining one of our retreats! 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 at the bottom of this form.

I am applying for:

Closed/Reunion In-Person Retreat | September 26-28
Traditional In-Person Retreat | November 7-9

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.

Full Name

First Name *

Last Name *

Email Address (Required)

Phone Number (Required)

Home Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Date of Birth (Required)

What are your pronouns?

She/Her/Hers
They/Them/Theirs
He/Him/His
Other

Please list your pronouns if not listed in the options above:

What agency/attorney handled your placement? (Required)

Retreat Experience

Have you attended an On Your Feet Retreat before?

If you have attended an On Your Feet Retreat in the past, please list the type of retreat(s) and the year(s) attended.

Traditional, Virtual, Veteran's, Closed/Reunion, Adoptive Mom/Birthmom

Why would you like to attend an On Your Feet Retreat? (Required)

What do you hope to get out of the retreat? (Required)

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I am completing this application on behalf of someone else. My name is:

First Name

Last Name

My relation to the prospective attendee is:

My email address is:

My phone number is:

Release of Information

This release does three basic things:

Gives us permission to contact the agency/attorney who you worked with
Allows us to use non-identifying information in our statistical analysis to evaluate the effectiveness of our services and obtain funding to support our programs
Enables us to collaborate as a team to provide the best possible programs and services.
I, name entered below, give permission to On Your Feet to contact references and the adoption agency that provided services to me during pregnancy and placement. I am aware that On Your Feet gathers data for research and funding purposes. I am also aware that signing this release allows my adoption story to be shared in On Your Feet's printed materials and/or website/social media pages without using confidential data or identifying information, such as names and addresses.
By signing this release, I understand this allows all pertinent On Your Feet Foundation personnel/staff to collaborate on my behalf as a team, to provide me with the best possible services.

Signature:

First Name *

Last Name *