About You

First name

Last name

Email

Phone

Pronouns:

Age Range:

Anything else you'd like us to know about who you are and what identities you hold?

How did you hear about this retreat?

Tell us a little bit about who you are, and what you want to be practicing in this season of your life.

What do you know about what supports you when you are in a new environment, or outside your comfort zone?

What specifically interests you about this retreat?

Which of the following activities are you most excited about? Choose 5.

Do you have any dietary restrictions?

Do you have any accessibility needs to be aware of?

Finances

I understand that payment for this retreat is in two parts: a $400 initial deposit that covers our operating expenses, and a second facilitator's offering payment on the final day of the retreat, on a sliding scale of $350 - 1100. While we do not you need you to make a commitment to an amount for the second offering, please let us know a range below you would be comfortable paying. We also have limited scholarships available.

For the second payment, I anticipate being able to pay in the range of:

$350 - 600 ($750 - 1000 total including deposit)

$600 - 850 ($1000 - 1250 total including deposit)

$850 - 1100 ($1250 - 1500 total including deposit)

I would need a scholarship to attend ($100 deposit + $100 - 300 second payment)

I would like to contribute towards a scholarship fund

Travel

Where are you based / where will you be traveling to the Hostel from?

How do you plan to travel to the Hostel?

I will get myself to the Hostel.

I will need a pick-up from the Brunswick bus station or airport.

I'll be flying into the Jacksonville Airport and looking to carpool/split a ride with others.

I'll be flying into the Savannah Airport and looking to carpool/split a ride with others.

I will be driving to the Hostel and would be willing to pick people up from nearby airports / bus stations.

I'm not sure yet!

Accomodations

I understand that the Hostel's accommodations are simple & rustic, with screen walls & no heat, and I will bring what I need in order to be warm & comfortable (including sleeping bag / electric blanket). Nighttime temperatures will likely be in the 40s and could get down to freezing.

Regular pricing is based on staying in shared lodging. We have limited private cabins & treehouses available for an extra $100 fee, due with the deposit.

I would like to stay in shared lodging.

I would like to stay in a private cabin/treehouse by myself for an extra $100 fee.

I would like to stay in a private cabin/treehouse and share a bed with someone who is coming with me ($100 fee split between both people).

Please share if there is anything specific you'd like us to know about your request for a private cabin, or if there is someone you'd like to room with.

Are you interested in staying an extra night for "Trade Day?"

Yes!

Not sure yet.

No.

Participants are responsible for booking any additional nights at the Hostel themselves.

Final details

Do you have a preference for how we host our community group chat?

I prefer a WhatsApp group chat.

I prefer a Discord group chat.

I have no preference.

Other

I understand that the orientation call on 12/15 and integration call on 1/26 are important parts of this group process and will do all in my power to be there live.

I understand that this is a queer-led & "queer-centric" retreat, open to anyone who shares the value of challenging heteronormativity & the gender binary, has experience sharing space with queer & genderqueer folks, is practiced in using gender-inclusive language, and is comfortable and experienced with receiving feedback gracefully.

I understand that it is my responsibility to take a COVID test before traveling to the Hostel, and a second test will be provided for me to take upon arrival. If I test positive before travelling I should not attend; if I test positive upon arrival I have the choice of staying at the Hostel and partially participating in the retreat when it's possible to do so masked, outdoors, and at an appropriate distance.

Do you have any questions for us?

Anything else you want to say or want us to know?

Yes, subscribe me to your newsletter.

Jordan Mudd

HEARTH RETREAT APPLICATION

About You

Finances

Travel

Accomodations

Final details