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Birthparent Services

2020 On Your Feet Birthmom Retreat Application

Personal Information

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 Jennifer or Abigail.

First Name
Last Name
Address Line 1
Postal Code
Date of Birth

Emergency Contact Information

First Name
Last Name
Phone #

Retreat Selection

Please select ALL that apply:
Have you attended an On Your Feet Retreat before?
Traditional, Veteran's, Closed/Reunion, Adoptive Mom/Birthmom, Mini-Retreat

Adoption History

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

Retreat Questions

Are you currently involved with any counseling or therapeutic services?
Following the retreat, are you interested in pursuing a counseling grant, with an adoption-competent therapist in your area?

Medical Infomation, Allergies and Drug Use

Are you using/have you used illegal drugs within the past 6 months?
Your answers will be kept confidential.
Allergies/Medical Conditions/Dietary Restrictions

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 people who have previously attended retreats.

Registration closes one month 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.

The cost for an individual to attend a birthmother retreat is approximately $400. However, retreats are underwritten by the On Your Feet Foundation. Because of this, On Your Feet is able to ask each birthmother to pay only a discounted amount to attend: Spring/Fall $100 and $150 for the Veteran's Retreat. If the discounted amount is unattainable, monetary grants are available for applicants who demonstrate financial need. Applicants can 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 available. Registrants are responsible for the cost of their transportation to/from retreats.

Registration Process

Retreat registration is a 3-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: 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. *If applying for the Veteran's Retreat, you will be sent a separate short questionnaire to complete.

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.  Please note, registration is not finalized until the deposit is received. If the deposit is not received within 3 days of being notified of an approved application, the registrant’s spot will be forfeited.

Approximately two weeks prior to the weekend, attendees will be emailed a letter with detailed packing information as well as the name of their "buddy." Each new attendee will be assigned a buddy (a birthmom who has previously attended a retreat), who will contact the newbie to answer any questions they may have. This will also give attendees a friendly face (or voice!) to greet them when they arrive for the weekend.

Remember, you must reserve your spot with a $20.00 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 or Abigail.

Disclaimer: No alcohol or drugs are allowed at the retreat. This is a policy of On Your Feet Foundation, as well as the owners of our retreat homes. If a retreat attendee or facilitator is found with drugs and/or alcohol or using drugs and/or alcohol during the retreat, consequences may include being sent home immediately and possibly at their own expense.  There will be no refunds issued. Upon discretion of On Your Feet Foundation, further retreat grants may be jeopardized.

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


Retreat Deposit and Payment

To secure your spot, we request that you pay a $20 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.

I am interested in:
Please check all that apply.
Payment Option
Retreat Payment

Your total payment will be

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