Applicants' Information

Thank you for your interest in Rett's Roost Bereavement Retreats. Both Grief is Love Bereavement retreats will take place in the lovely beach town of Ogunquit, ME April 25th and November 21st, 2020. These one day retreats are for parents only this year. Please take time to fill out our application. You will be informed within 72 hours of submitting whether you have been accepted to attend. If you don't hear from us, feel free to check in at rettsroost@gmail.com. Allow yourself 20 minutes to complete.

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* 2. Family Information

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* 3. Name of parent or guardian (a):

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* 4. Name of parent or guardian (b):

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* 5. Additional Email Address for Communications:

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* 6. Additional Phone Number for Communications:

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* 7. Emergency Contact Information (cannot be on retreat)

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* 8. Which race/ethnicity best describes your family? (Choose all that apply)

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* 9. Please share the name of your child that died:

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* 10. Preferred gender of child no longer with you

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* 11. Birthday

Date

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* 12. Date of Death

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