The Brain Injury Association of Ohio Caregiver Retreat Registration
The Caregiver Retreat will be held in Hinkley, Ohio ( Northeast Ohio) on April 17-19 2026. It will include accomodations Friday-Sunday (you can leave and come back if you need to care for a survivor at night and only attend daytime activities). We will be asking for a $40 deposit that will be returned to you at the retreat because space is limited. There is space for 11 individuals to spend the night with shared sleeping arrangements, there are some queen size beds and some twin bunk beds. If you have a specific accomodation need regarding where you sleep, please indicate so in your registration. We also have the option of a day registration where you can come during the day and leave at night.
Caregiver Information
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
An Emergency Contact for you While at the Retreat
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
How did you hear about us?
*
Please Select
Newspaper
Internet
Magazine
Other
Please Specify
*
Who do you care for?
*
Spouse/partner
Child
Parent
Other family member
Friend
What type of injury did the individual you care for have?
*
Traumatic Brain Injury
Stroke
Anoxic/Hypoxic
Tumor
Other/Unsure
How long ago was the injury?
*
Less than 1 year
1-3 years
3-5 years
5+ years
Do you currently receive caregiver support or respite services?
*
yes
no
Do you have any dietary restrictions that we should consider?
*
Are you planning to stay overnight or just attending during the day?
*
Overnight both Friday and Saturday
Overnight Friday only
Day Only Saturday
Do you have any mobility, sensory or acccesibility needs we should be aware of?
*
Do you have a preferred roommate? We will attempt to honor all requests, but cannot guarantee.
Are there any medical considerations we should be aware of in case of emergency?
*
Are you comfortable participating in the following activities? Check ALL that apply.
*
Gentle Movement
Hiking
Mindfulness
Outdoor activities
Some retreat sessions may include group discussion and reflection. You are always welcome to step out.
*
I understand and I am comfortable with this
Would you like access to: (check ALL that apply)
Quiet Space
One on One support/check ins
Peer discussion groups
What are you looking forward to the most at this retreat?
*
What feels hardest right now in your caregiving role?
*
Photos and videos may be taken during the event for the purpose of sharing our work with funders and/or marketing. Do you consent to your photo/video being taken and shared?
*
Yes
No
This retreat is intended to be a safe, supportive, and respectful space. Participants may share personal experiences related to caregiving, brain injury, and their own well-being.By registering, I agree to: Respect the privacy of all participants. Keep personal stories, names, and identifying details shared during the retreat confidential. Not share or discuss another participant’s experiences outside of the retreat without their explicit permission. I understand that I am always free to share my own experience, but not the experiences of others.
*
I acknowledge and agree to uphold this confidentiality agreement.
The Brain Injury Association of Ohio is committed to creating a welcoming, inclusive, and respectful environment for all retreat participants.By registering, I agree to:Treat all participants, facilitators, staff, and volunteers with kindness and respect. Honor differences in experiences, perspectives, identities, and coping styles. Listen without judgment and allow space for others to share. Refrain from disruptive, harmful, or disrespectful behavior, including harassment or discrimination of any kind. I understand that retreat facilitators reserve the right to address behavior that compromises the safety or well-being of the group, which may include asking a participant to step away from an activity or, if necessary, leave the retreat.
*
I acknowledge and agree to follow this code of conduct.
Because this retreat includes lodging, meals, and limited space, we must manage our registrations very carefully. By registering, I acknowledge that: I will let BIAOH know immediately if I can no longer attend so that my spot can be offered to someone on the wait list. Cancellations must be made by 4/10/2026 to be eligible for a refund of your deposit. Cancellations after this date may be non-refundable. If I am unable to attend, I understand that my spot may be offered to another caregiver. In the event of unforeseen circumstances, I may contact the Brain Injury Association of Ohio to discuss my situation. We understand that caregiving comes with unpredictability. Please reach out if circumstances change — we’re here to work with you whenever possible.
*
I acknowledge and understand the cancellation and attendance policy.
Caregiver Self-Assessment Questionaire
Caregivers are often so concerned with caring for the relative’s needs that they lose sight of their own well-being. Please take just a moment to answer the following questions. We will ask you to complete this survey again at the end of the retreat.
Had trouble keeping my mind on what I am doing
*
Yes
No
Felt that I couldn’t leave my relative alone
*
Yes
No
Had difficulty making decisions
*
Yes
No
Felt completley overwhelmed
*
Yes
No
Felt useful and needed
*
Yes
No
Felt lonely
*
Yes
No
Been upset that my relative has changed so much from his/her former self…
*
Yes
No
Felt a loss of privacy and/or personal time
*
Yes
No
Been edgey or irritable
*
Yes
No
Had sleep disturbed because of caring for my relative
*
Yes
No
Had a crying spell(s)
*
Yes
No
Had back pain
*
Yes
No
Felt ill (headaches, stomach problems or common cold)
*
Yes
No
Been satisfied with the support my family has given me
*
Yes
No
Found my relative’s living situation to be inconvenient or a barrier to care
*
Yes
No
On a scale of 1 to 10, with 1 being “not stressful” to 10 being “extremely stressful,” please rate your current level of stress.
*
On a scale of 1 to 10, with 1 being “very healthy” to 10 being “very ill,” please rate your current health compared to what it was this time last year.
*
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Caregiver Retreat Deposit -Overnight Registraion
$
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
Caregiver Retreat Deposit - Day Participation Registration
$
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
Caregiver Retreat Waitlist Overnight Registration - Select only if the regular registration is sold out. (we will collect the deposit from you if we are able to move you off the waitlist)
$
Free
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