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Virtual Just Us Retreat 2021

Father Information

We are excited you are interested in joining CBTF for our Virtual Just Us Retreat on October 22 (6-9PM) and 23rd (10AM-1PM Eastern). This retreat is designed to give fathers a chance to meet and bond with other fathers, provide quality time with their child, and have some fun together. The information below is used for record keeping and will help determine program content. All information is confidential. We continue to look forward to the time when we can all meet in person again. We hope to schedule an in person retreat for the spring of 2022 so stay tuned! Until then, we look forward to seeing you online!
1.Father's name
2.Relationship
3.Address
4.If you would you like your contact information shared with other attendees, please indicate what information we can share.
5.Father's birthdate
6.Father's ethnicity
7.Father's shirt size. 
8.Is this your first time attending Just Us
9.Please list any issues or challenges that may interfere with your online experience (hearing loss, visual impairment, slow internet connection etc.)
10.We may offer concurrent sessions for survivors and fathers. Do you and your child each have access to your own device?
11.Do you have any goals or expectations for the retreat?
12.Are there any topics you would like discussed at the retreat?
13.Please describe 2-3 strengths in your relationship with your child (brain tumor survivor)
14.Please describe 2-3 challenges in your relationship with your child (brain tumor survivor)
15.Please describe one of your child's accomplishments or successes over the past year. 
16.Please list an emergency contact for you and your child (name, relationship and phone number)
17.Do you or your child have any conflicts with the retreat (i.e. is there a window of time you will not be able to attend?).
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