ABOUT US
OUR MISSION, VISION AND VALUES
Our Story
Staff
Gnorman the Gnome
Board of Directors
Monthly Newsletters
Founders
>
Dr. Dawn
Dr. Craig
Corporate and Community Partners
Annual Report
SUPPORT US
Donate
WISH LIST
Volunteer
Volunteer Team Page
Teen Volunteers (YEP)
RETREATS
TSP SINGLE FAMILY RETREAT
Still Life Virtual Retreats
Tour The House and View the Schedule on VRBO
PAY-IT-FORWARD VACATION
STORE
Donate
CONTACT US
Family Retreat Initial Application
Sign Up for News
ABOUT US
OUR MISSION, VISION AND VALUES
Our Story
Staff
Gnorman the Gnome
Board of Directors
Monthly Newsletters
Founders
>
Dr. Dawn
Dr. Craig
Corporate and Community Partners
Annual Report
SUPPORT US
Donate
WISH LIST
Volunteer
Volunteer Team Page
Teen Volunteers (YEP)
RETREATS
TSP SINGLE FAMILY RETREAT
Still Life Virtual Retreats
Tour The House and View the Schedule on VRBO
PAY-IT-FORWARD VACATION
STORE
Donate
CONTACT US
Family Retreat Initial Application
Sign Up for News
FAMILY RETREAT INITIAL APPLICATION
If you or someone you know would like to apply for a
Still Place
Family Retreat, please fill out the fields below.
*
Indicates required field
Who is filling out this application?
*
First
Last
What is your relationship in the family?
*
Parent
Other
Email
*
Phone Number
*
Please share a phone number where you can receive text messages if possible.
How did you hear about The Still Place?
*
Facebook/Support Group
Ansley's Rainbows of Hope
Past TSP family
Other...
Address
*
Line 1
Line 2
City
State
Zip Code
Country
What County do you live in?
*
Requested retreat dates
*
We offer full week retreats. Sunday evening to Sunday morning (ideally). Please share 3 different weeks that will fit your schedule. We will be in touch!
Parental relationship
*
Married
Single
Shared parenting
Foster
Adoptive Relationship
Strains/challenges
Father's Name
*
First
Last
Mother's Name
*
First
Last
Other (partner)
*
First
Last
List your children with names, age, and birthdates (including birth year)
*
It helps us to plan age appropriate activities if we know how old your children will be we you come to The Still Place for your retreat.
Will friends or family members other than those listed above be coming?
*
Yes
No
If yes, who will be joining you and what is their relationship to your family?
*
Please share first and last names and ages. This helps us to plan.
Tell us about your child's illness
*
Tell us the name of your child's illness. We will cover details in your family interview.
Which child/children are ill
*
If you have more than one child in your family with an illness, please let us know which child has which illness so we can know how to make your retreat the best it can be for each of them.
Have you experienced a Still Place Retreat in the past?
*
Yes
No
How long has it been since you had a family vacation?
*
Hours worked each week
*
Paid vacation/no paid vacation
*
I agree to receiving marketing and promotional materials
*
Submit