Bereavement retreat 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 [email protected]

Let’s start with the yummies:

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. *

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

2. The following Art activities would be interesting to me: (Please choose all that interest you) *

4. Appalachian Homecrafts (Please choose all that interest you) *

5. Appalachian Adventure (Please choose all that interest you) *

Horseback riding Watersports: Kayaking, Stand Up Paddle Boarding, Tubing Ziplining

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

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.

​Still Your Mom Retreat Attendee Questionnaire

Still Your Mom Retreat Attendee Questionnaire