August 23-24 The Grounded Leader Retreat: Burnout Prevention for Women in Leadership
Name
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Middle Name
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Address
Street Address
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Emergency Contact Number
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Please write a few words about what you hope to get from your retreat experience
Please choose the accommodation option that feels most comfortable for you. You’ll have your own bed, with shared spaces such as bathrooms, living rooms, and kitchens to enjoy together.For each bed, we provide a mattress protector and fitted sheet. Please bring your own pillow and sleeping bag or comforter.A quick note about the Bunk House: it does not have an attached bathroom, but there is a nearby outhouse, and you’ll also have access to two indoor bathrooms—one in the Beach House and one in the Jack Pine Cottage.If you love having your own private space and feeling closely connected to the land, you’re also welcome to bring your own tent (or borrow one) and set it up in our beautiful riverside tenting area. Beds located in the Jack Pine Cottage are reserved for participants with medical needs that require overnight access to a bathroom or electrical plug-ins.
Bunkhouse bottom bunk
Bunkhouse top bunk (Choose this if you are physically able and can safely climb a ladder)
Bring Your Own Tent
I would like to tent but need to borrow one
JackPine Hut Private Room with Single Bed (reserved for those with medical needs that require overnight access to a bathroom or electrical plug-ins)
JackPine Hut Private Room with Double Bed (reserved for those with medical needs that require overnight access to a bathroom or electrical plug-ins)
JackPine Hut PullOut Couch #1 (reserved for those with medical needs that require overnight access to a bathroom or electrical plug-ins
JackPine Hut PullOut Couch #2 (reserved for those with medical needs that require overnight access to a bathroom or electrical plug-ins
Fill in the blank. The song that always lifts my spirits is…
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Please list any food allergies, dietary restrictions/preferences
Would you consent to your email being included in group emails to all registered participants?
Yes
No
This retreat honours rest, agency, and the nervous system’s need for choice. Photography is approached with the same intention. Please select the statement that best reflects your preference.
I am comfortable with photos being taken and posted to media for the purpose of marketing Wild Grounded Retreats
I do not want any pictures taken of me
I am ok with pictures being taken for the purposes of preparing a private slideshow that is only shared with participants of the retreat
Please use this space to note any questions, concerns, or accommodation requests you’d like to share. I can connect with you by phone, if needed, to discuss how best to support you in having a deeply restful and nourishing retreat experience.
Retreat Payment:The total cost of the retreat is $450 + HST ($508.50).To reserve your space, a non-refundable deposit of $127.12 is required. This deposit secures your accommodation allows us to begin preparations for the group.If it feels supportive, you’re welcome to choose a 4-installment payment plan of $127.12 x 4. The full balance is due by August 1, 2026. Payment can be made via e-transfer to:wildgroundedretreats@gmail.com Acknowledgement & Consent: I have taken time to read the information above and understand the payment policies for this retreat. By typing my name below, I am confirming my agreement and my intention to participate with care and clarity.
Retreat Cancellation Policy: We understand that life can be unpredictable, and we aim to balance compassion with the practical realities of retreat planning.The $127.12 deposit is non-refundable. Cancellations made on or before August 1, 2026 will receive a refund of any payments made minus the deposit. Cancellations after August 1, 2026 are non-refundable, as retreat costs and accommodations will have been finalized. If you’re unable to attend, you are welcome to transfer your spot to another person (with prior notice), or we’re happy to explore applying your payment as a credit toward a future Wild Grounded retreat. Thank you for understanding and for honouring the care and energy that goes into creating this experience. If you have questions or would like to talk through what feels right for you, please don’t hesitate to reach out. Acknowledgement & Consent: I have taken time to read the information above and understand the cancellation policies for this retreat. By typing my name below, I am confirming my agreement and my intention to participate with care and clarity.
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