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PAY-IT-FORWARD VACATION
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Tour The Houses and View the Schedule on VRBO
ABOUT US
OUR MISSION, VISION AND VALUES
Our Story
Staff
Gnorman and Gnorma Gnome
Board of Directors
Monthly Newsletters
Founders
>
Dr. Dawn
Dr. Craig
Corporate and Community Partners
Annual Reports
Volunteer
Volunteer Team Page
Teen Volunteers (YEP)
RETREATS
A TYPICAL FAMILY RETREAT
>
Family Retreat Initial Application
Family Retreat Forms
Still Life Virtual Retreats
Host Family Application
Bereavement Retreat Initial Application
Tour The Houses and View the Schedule on VRBO
STORE
CONTACT US
Sign Up for Newsletter
DONATE
Give the Gift of the Month
PAY-IT-FORWARD VACATION
>
Tour The Houses and View the Schedule on VRBO
Still Your Mom Retreat Attendee Questionnaire
We are looking forward to welcoming you to The Still Place and providing a unique retreat experience as you gather with a small group of other bereaved mothers to experience rest, renewal and re-creation as we hold a safe space for you to share, be pampered and supported on this most difficult journey. No matter what, we know YOU are Still their Mom.
Thank you for allowing us to get to know you a little more before the retreat. Everything we do at The Still Place is small, unique and born of stillness. We try to make each retreat unique based on our participants preferences.
Please complete this and return it to info@thestillplace.org
Let’s start with the yummies:
*
Indicates required field
1. What are your favorite munchies, comfort foods and snacks? It’s okay if you really like fruit and veggies but let us know exactly what you love and crave most, promise we won’t judge..even if it's flamin’ hot cheetos.
*
2. Do you have any food allergies or dietary restrictions?
*
3. What are your dietary preferences?
*
Omnivore
Gluten Free
Vegetarian
Vegan
Other
4. Do you drink alcoholic beverages
*
Yes
No
Occassionaly
Favorite beverages alcoholic and non-alcoholic
*
Shirt size
*
S (Small)
M (Medium)
L (Large)
XL (Extra Large)
2XL
3XL
4XL
In scheduling each retreat, we incorporate a little bit of art, nature, spirituality and Appalachian culture or adventure. The following questions are aimed at trying to find just the right amount of and mix of activities to best serve you. We also like to leave plenty of room for participants to leave any or all activities to spend quiet time alone if that is what you need most. Please keep in mind some of the activities are seasonal. We will do our best to find the sweet spot for everyone. (Please check all that apply)
1. I anticipate my energy heading into the retreat is best characterized as:
*
Exhausted
Needing quiet, slow and a good amount of alone time
Needing pampering
Ready to be social and meet new people.
Ready a little bit of everything and seek alone time as needed
Ready for an adventure
Other
*
2. The following Art activities would be interesting to me: (Please choose all that interest you)
*
Painting
Weaving
Felting
Collage
Creative Writing/Poetry
Printmaking
3. The following Nature Activities: (Please choose all that interest you)
*
Hiking
Creek Dipping
Yoga
Lake or Creek Swimming
4. Appalachian Homecrafts (Please choose all that interest you)
*
Quilting
Yarn work: Knitting, Crocheting
Needlework: Embroidery
Gardening
Cooking
Moonshine Demo and tasting
5. Appalachian Adventure (Please choose all that interest you)
*
Horseback riding
Watersports: Kayaking, Stand Up Paddle Boarding, Tubing
Ziplining
6. Pampering (Please choose all that interest you)
*
Massage
Reflexology
Reiki
Mani/Pedi
Restorative Yoga
Other Stuff:
1. Do you have a faith background/spiritual practice?
*
Spiritual not religious
Christian
Muslim
Buddhist
Hindu
Pagan
Agnostic
Atheist
Other
*
2. Will there be any special occasions or anniversaries during your time on retreat?
*
3. What are you most looking forward to at your retreat? (Please choose all that interest you)
*
Time alone
Time with other mothers
Space to share my grief journey and questions
Tools to help me live with the loss of my child
A place to share my child’s life and loss with other mothers
Time to be pampered
Grief Resources
4. Do you have any concerns about the retreat? (Please choose all that apply)
*
Family care
Scheduling
Time off work
Cost
Fear
Anxiety
Emotions
Other (Please feel free to share further)
*
5. What do you hope most to get out of coming to the retreat?
*
6. Is there anything you would like us to know about you that we didn’t ask?
*
7. We offer an additional night stay for you to relax, unwind and process. Do you plan to stay an additional night after the retreat? (This is highly recommended if you are able)
*
I will need to leave as soon as the event ends
I would like to spend the night after the retreat attends
I would like to stay a full day and night after the retreat ends
8. Please tell us how you plan to travel (check all that apply):
*
I plan to travel by plane
I plan to travel by car
I will be traveling in a rental car
9. Is travel assistance required for you to attend a retreat?
*
No, I do not need travel assistance to attend,
Yes, I can't come without travel assistance.
It would be helpful but not required.
Submit
