The goal of “Live Again Retreat” is to help as many as possible. To inquire if space is available or to learn more, please complete the form below. We review each case and try our best to help every qualifying person, if capacity permits. The “Live Again Retreat” Review Committee reviews each applicant. There is a $25 - $50 non-refundable suggested donation for the Retreat should you be accepted. There is no additional cost to attend the Retreat.
Fill out the form below to apply to attend the “Live Again Retreat” Program.
Upon receiving your information, the “Live Again Retreat” team will contact you within 2-3 business days. Thank you for notifying us and allowing us to be a part of your journey.
Name
*
First Name
Last Name
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Email
*
example@example.com
Father/Partner's Name
*
First Name
Last Name
Child's Name
*
First Name
Last Name
Child's Birth Date
*
-
Month
-
Day
Year
Date
Date of Loss
*
-
Month
-
Day
Year
Date
Do you have other children?
*
Yes
No
If you have other children, please list them & their ages below.
Emergency Contact #1 Name
*
First Name
Last Name
Emergency Contact #1 Phone
*
Please enter a valid phone number.
Emergency Contact #2 Name
*
First Name
Last Name
Emergency Contact #2 Phone
*
Please enter a valid phone number.
Your Story
*
Please use the space above to share your story.
Your Support System
Please list family members, friends, organizations, churches, etc. that are currently helping you.
Have you received counseling? Minimum 5 sessions?
*
Yes
No
If you answered "yes" to the previous question, please explain.
Any Food Allergies?
Please list above.
Any Medical Issues?
Please list above.
Interested in the following: (Please check any/all that apply.)
*
Fishing
Learning to surf
Kayaking
Paddleboarding
Beginners Yoga
Advanced Yoga
Biking
Walks on the beach
How did you hear about “Live Again Retreats?”
*
Form Completed By:
*
First Name
Last Name
I confirm I do not require support for any of the following: Co-occurring drug and alcohol related issues; Eating disorders; Persistent mania; Cognitive challenges; Non-compliance with prescribed medications; Actively suicidal; History of violence or exhibits violent tendencies; I also understand The Finley Project would not be an appropriate program for an individual who requires 24-hour visual monitoring or inpatient care.
*
I agree
I agree to the following: 1) I am more than one year after loss (must be 12 months post loss). 2) I have attended/have seen a licensed mental health counselor for a minimum of 5 sessions. 3) I am a minimum age of 18 for program participation. 4) I have a desire to explore and move through grief into new dreams/opportunities.
*
I agree
Submit
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