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Survivor Sister Retreat Application

Break The Silence Against Domestic Violence offers an Annual Survivor Sister Retreat for women affected by domestic violence. This program allows participants to engage in various workshops and activities throughout the course of a weekend. Together, our time is devoted to promoting individual development, bridging relationships amongst survivors, empowerment, and increasing awareness on mental health practices to encourage effective healing after trauma. We immerse survivors into a holistic healing journey created by survivors, for survivors. We believe a peer group approach encourages and supports an environment of true transformation and accountability for growth for each of our attendees.

First Name*

Please keep me informed.

Last Name*

Email Address*

Cell Phone

Address, line 1*

City*

State*

Zip Code*

Date of Birth*

Do you have children?*

Yes No

What is your relationship status?*

Have you ever been convicted of a crime?*

Yes No

How long has it been since you left your abuser?*

Are you comfortable sharing your story?*

Yes No

Tell us about your journey to survivor hood.*

Why would you like to attend a Survivor's Retreat?*

What do you hope to gain from the retreat?*

Accommodations: Allergies, Food, Sleep or Prescription Drugs

Shirt Size

Have you previously attended a Survivor Sister's Retreat?*

Yes No

Are you comfortable sharing a room with another survivor?*

Yes No

By clicking the box below, I agree to the following terms:

Confirmation Checkbox* Click here to view

I understand I must cover the cost of travel to and from the retreat and provide proof of purchase by 3/31/2023.
Upon acceptance, I agree to a possible background check.
I understand NO Alcohol or drugs will be brought to or consumed at the retreat. ( This can be a trigger for others,
therefore we DO NOT allow it)
I understand if I cancel my spot will be awarded to another survivor sister.
I understand I must make proper family and work arrangements prior to attending.
I understand I am attending the retreat for my own healing and should not practice advocacy or self-promotion at
our program.
I am not in an unhealthy relationship nor with my abuser.
I understand all workshops are given for survivors benefit and if there is a workshop I do not want to attend, that is
Ok. I do not have to attend.
I understand this program may be triggering
I give permission to share my story. ( Paper release will also be signed)
I agree to receive email correspondence from BTSADV

Print

By submitting this application, you confirm that all the information provided is true. Submission of an application does not guarantee acceptance into the Sister's Retreat. I understand that I will receive an e-mail from BTSADV notifying me of my acceptance and the next steps to take.

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Contact Us

BTSADV
530 Communication Cr
CO SP , CO 80905
719-309-1777
[email protected]

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Thank you for applying to attend this April's Survivor Sister Retreat!

Our Retreat is first come first serve based on payment of $800.00 registration fee. Please make sure to add [email protected] to your address book and check your spam inbox. If you are accepted into the retreat, further instructions will be sent regarding how to pay the registration fee and on the $150 non-refundable portion, COVID instructions, and travel accommodations that need to be purchased by March 29, 2024, After April 1 2024 there will be NO REFUNDS!

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