Virtual Retreat Application : Birthparent Services : On Your Feet Foundation

Virtual Retreat Application

Retreat Information

Thank you for your interest in our 2024 Spring Birthmom Virtual Retreat which takes place on Saturday, May 18th, 2024.*

For all of our retreats, a number of spots are reserved for first-time attendees and a number of spots are reserved for women who have previously attended retreats. Once spots are filled, a wait-list will be started.

Registration will close on Friday, April 26th. If you are placed on the wait-list and do not get a space, you will be given priority to attend the next virtual retreat.

If the spaces reserved for new attendees are not filled, the spaces will be offered to birthmoms who have previously attended retreats.

The cost for an individual to attend a birthmother retreat is approximately $100; however, retreats are underwritten by On Your Feet Foundation. Because of this, On Your Feet is able to ask each birthmother to pay only $35 to attend ($25 if application is received by Friday April 5th, 2024). If $35 is unattainable, monetary grants are available. Applicants can also make arrangements with On Your Feet staff to set up third-party payments. $25 early bird registration is available up to 6 weeks prior to the retreat.

Registration Process

Retreat registration is a 3-step process. This helps On Your Feet plan retreats, which optimizes the attendees’ experience. This also ensures that all applicants will have sufficient support post-retreat.

Step 1: Complete the retreat registration form and, if needed, the retreat grant application. A representative will review your form(s) and contact you within 3 business days.

Step 2: 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.

Step 3: Upon receiving the completed survey and consent, an On Your Feet Retreat Facilitator will contact you to introduce herself and review the survey. Once your spot is confirmed, a $10 non-refundable deposit will be due within 3 days of meeting to finalize registration. Registration is not finalized until the deposit is received. If the deposit is not received within 3 days, the registrant’s spot will be forfeited.

Approximately two weeks prior to the weekend, attendees will be expected to pay the balance of the retreat fee. Once that is received, your retreat kit will be mailed to you.

Remember, you must reserve your spot with a $10.00 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 Jennifer.

*Please note, our virtual retreats are now one day only.

Please fill out the application to the best of your ability. There are no right or wrong answers. If you have questions, please reach out to Jennifer or Vicki.

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 is your Date of Birth?

What are your pronouns?

She/Her/Hers
They/Them/Theirs
He/Him/His
Other/Prefer not to say

If Other, please indicate your pronouns:

Race/Ethnicity (please check all that apply):

Black/African American
Hispanic/Latino
Asian
Native Hawaiian/Other Pacific Islander
Indigenous Peoples/First Nations/Inupiaq/Inuit
White/Caucasian
Other/Prefer not to say

If Other, please indicate:

Are you eligible for Medicaid or Government Assistance?

What is the highest level of education you have completed?

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, Veteran's, Closed/Reunion, Adoptive Mom/Birthmom, Mini-Retreat

Type of Adoption

Agency
Private/Attorney
Kinship
Foster Care

Describe your placement (open/closed/in reunion/other/etc): (Required)

What agency/attorney handled your placement? (Required)

Name(s), DOB and Placement Date of Child(ren) Placed (Required)

Do you feel the placement was your choice?

Yes
No
Other

Are you parenting?

If you are currently parenting other children, please list their name(s) and age(s):

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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What type of post-retreat support will you have? Please explain. (Required)

I am interested in:

Please check all that apply.

Receiving a grant to attend
Making an additional monetary donation

Are you using/have you used illegal drugs within the past 6 months?

Your answer will be kept confidential.

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?

Yes
No
I'm not sure.

Please provide any additional information, if any, that you would like us to know:

I have read and understand the above section titled Retreat Information.

Release of Information

This release does three basic things: it gives us permission to contact your agency, whom we depend on for referrals; it allows us to use your non-identifying information in our statistical analysis to evaluate the effectiveness of our services and to obtain funding from donors; and it enables us to collaborate as a team to provide the best services to you.

I, name entered below, give permission to On Your Feet Foundation to exchange or release information regarding adoption services. I also give permission for On Your Feet Foundation to contact references and the adoption agency that provided services during pregnancy and adoption placement.

I am aware that On Your Feet Foundation is in the process of gathering research data and some of the statistical information gathered may be used for research. I am also aware that signing this release allows my adoption story to be shared in likeness in the On Your Feet Foundation printed materials and/or website/social media pages. No confidential data or identifying information such as names and addresses will be used for this purpose.

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 the best services deserved to me.

Signature

First Name *

Last Name *

Date

Month

Day

Year

Retreat Deposit and Payment

To secure your spot, we request that you pay a $10 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.