TACP Foundation Resilience & Restoration Application

2025 TACP Foundation Resilience & Restoration Registration Form

Thank you for your interest in joining our group retreat specifically designed for military veterans. Please fill out the following application form to help us better understand your needs and ensure a positive experience for all participants.
Name*

First NameNick Name/Call SignLast Name
Birth Date*

MonthDayYear
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Entered Into Service*

DayMonthYear
Date
Date Separated From Service

DayMonthYear
Date
Flight*
Number
Rank At Discharge*
Type of Discharge*
Emergency Point of Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*

We'd like to know a little more about you.

Your response is taken into consideration to determine eligibility and qualification. Additionally, we anonymously use responses to garner future donor sponsorships, affording opportunities for additional TACPs and their families. Please provide as much insight and details that you are comfortable this, helping us, help you and this community. Thank you!
Why are you interested in attending this retreat? *

0/0
What do you hope to gain from participating in this retreat? *

0/0
Have you attended a TACP Foundation sponsored group retreat before?*

YesNo
If yes, please describe your experience.

0/0
What activities or workshops are you most interested in participating in during the retreat? *
Is there anything else you would like us to know about you that might help us make this retreat as beneficial as possible for you or consider when making our selection? *

Disclamers
Applicant {name} acknowledges and agrees that any information provided is not subject to the requirements of the Health Insurance Portability and Accountability Act (HIPAA) as it does not involve the provision of healthcare, the transmission of electronic health information, or any activities falling within HIPAA's purview. Therefore, the organizers of this retreat are not obligated to follow HIPAA regulations. NEVERTHELESS, APPLICANT confidentiality will be respected and maintained to the highest degree possible within the scope of the retreat activities.

Priority for acceptance into the retreat will be given to new applicants over those who have previously attended. This policy aims to provide as many individuals as possible with the opportunity to benefit from the retreat experience. Returning participants are encouraged to reapply, but their applications will be considered only if there are available spots after accommodating new applicants.
Consent & Agreement

I understand that this is a group retreat and agree to respect the confidentiality and privacy of all participants.I acknowledge that this retreat is not a substitute for professional medical or psychological treatment.I agree to participate fully in retreat activities to the best of my ability.I grant the TACP Foundation the right to capture, use, and distribute my image, likeness, and voice in photography, video, and other media for marketing and promotional purposes.I agree to participate provide feedback through digital media (forms, surveys, etc.)
Signature

Powered by Jotform SignClear
Should be Empty:

2025 TACP Foundation Resilience & Restoration Registration Form

Initial Health Screening

We'd like to know a little more about you.

Disclamers