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Birthparent Services

Virtual Retreat Application

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 below.

First Name
Last Name

I am applying for the:

Personal Information

First Name *
Last Name *
Address Line 1 *
City *
State/Province *
Postal Code *
What is your Date of Birth?
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?

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.

Adoption History

Type of Adoption
Describe your placement (open/closed/in reunion/other/etc):
Do you feel the placement was your choice?
Are you parenting?

Retreat Questions

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?
I am interested in:
Please check all that apply.

Veteran's Retreat Questions

If you are applying for the Veteran's Retreat, complete this section. If you are applying for the Spring or Fall Traditional Retreats, please move on to the next section titled Retreat Information.

Retreat Information

Thank you for your interest in attending one of our Virtual retreats!

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. 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 birthparents 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 early bird discount). 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.

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.

First Name *
Last Name *

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.

Credit Card Information

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
Your bank account will be charged
Payment Option
Retreat Payment

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