Self-Directed Retreats

...

* These fields are required

1 Welcome

Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Emergency Contact Name *
Emergency Contact Phone Number *
Gender
Medical & Mobility Notes	Please let us know if you require ground-level accommodations or have other special needs of a medical nature.
Email newsletter	Please send me the email newsletter
Birth Date
Dietary Restrictions	Include allergies or dietary restrictions i.e. gluten free
Proposed Date of Arrival *
Proposed Date of Departure *
How long have you been practicing? In which tradition/religion? *
Have you done a self-directed retreat before? *
What do you hope to gain from this retreat? *
Are you able to commit to several hours/ week of selfless service without accommodations or restrictions?	includes lifting, cleaning, cooking, household duties, etc.
Are you on any medication; if so, what kind and what is it treatment for? *
Have you undergone trauma that you are currently healing from or are you in personal crisis right now? *
How did you hear about us?
Cancellation Policy	I have read and agree with the cancellation policy below.As a dana-based, volunteer-based center, we are unable to provide refunds. At this time, all retreats are non-refundable. We understand that emergency circumstances arise. In this case, please submit in writing to explain the nature of the emergency circumstances to retreat@heartwoodrefuge.org to secure a credit for future Heartwood offerings.
What is your intention for this retreat?

50% Deposit	$0
	$0 next payment date * last payment amount will be $0