Spring 2024 Community Grief Retreat
April 13 - April 14, 2024
AGES: 18 yrs and older
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TRANSLATE THIS FORM: Español, Português, Tiếng Việt, Tagalog, Kreyòl ayisyen
FOR WHOM?
I WILL PARTICIPATE
YOUR (PARENT/GUARDIAN) NAME:
YOUR (PARENT/GUARDIAN) CONTACT INFORMATION:
NAME:
(not parent)
CONTACT INFORMATION:
(OPTIONAL)
BIRTHDATE:
Please enter a valid birthdate here...
GENDER:
Please enter a gender information here...
use button or write in anything!
Male
Female
Non-Binary
PRONOUNS:
use button or write in anything!
He/Him/His
She/Her/Hers
They/Them/Theirs
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HOUSEHOLD/FAMILY DETAILS:
PARTICIPANT MAILING ADDRESS:
* ONLY IF OUTSIDE OF USA
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HOW DID YOU FIND US?
Please help us understand
which of our marketing efforts are most effective
by checking the factor or factors
that most influenced your decision to register!
WORD-OF-MOUTH:
A friend or family member told me about it
WEB:
I searched for something on the internet and found your website
SOCIAL-MEDIA:
I saw something on social media: Instagram, Facebook, etc.
EMAIL:
I received a marketing email or e-newsletter from you
BROCHURE:
I received or read a printed brochure or program catalog
POSTER:
I saw a poster on a bulletin board
PRINT:
I saw a printed advertisement or article in a newspaper or magazine
ADVISOR:
A school counselor, advisor, or paid consultant recommended it to me
ENCOUNTER:
I randomly encountered your staff or students while we were out in the world
EVENT:
I found your table or display at a school, fair, or other public event
MYSTERY:
A mysterious force has led me here; I cannot explain it
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YOU MUST CHOOSE ONE OF THESE OPTIONS:
$500.00
TUITION A-SUPPORTING-TIER-GRIEF
This tuition tier supports those paying on the lower end of the scale and helps Journeys develop future programs
$445.00
TUITION B-STAFFING-TIER-GRIEF
This tuition tier covers the full costs of running our program with administrative overhead.
$385.00
TUITION C-SUSTAINING-TIER-GRIEF
This tuition tier covers our direct costs of running the program.
$325.00
TUITION D-SUPPORTED-TIER-GRIEF
This tuition tier falls short of covering our direct expenses.
$0.00
TUITION Z-FINANCIAL-AID
Choose this option to apply for financial aid. You will receive a link to our financial aid application and a link to pay a deposit in an email following registration. We ask that families applying for financial aid submit a deposit in any amount that currently works for your family. We do not reserve a spot without a deposit.
SHOPPING CART
ADJUST QUANTITIES:
ITEM
QUANTITY
SUBTOTAL
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NEWSLETTER OPT IN
Please opt in below to be added to our newsletter email list!
Would you like to be added to our newsletter to receive occasional emails about our programs and community updates?
YES
NO
SUBMIT THIS SECTION
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ALMOST DONE, KEEP GOING!
PLEASE COMPLETE THIS VALIDATION:
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