Apply for a Retreat | Bloom Care

Bloom Care Oncology Support Wellness Retreat Application

Thank you for your interest in the Bloom Care Oncology Wellness Retreat. This retreat is designed to support cancer patients, survivors, and care givers through community wellness activities, and restorative experiences. Please complete application below. Selected participants will be contacted with additional retreat details and instructions to secure their spot.

Basic Information

Full Name Email Address Phone Number City & State Age Emergency Name/Number

Cancer Journey

Which best describes your experience? What type of Cancer? What year were your diagnosed? What year did your caregiving journey begin?

Personal Experience

What has been one the most challenging parts of your cancer journey? What inspired you to apply for the Retreat? What are you hoping to gain from this experience?

Wellness Participation

Are you comfortable participating in group discussions? Are you able to walk independently without assistance? Do you have any dietary restrictions or food allergies?

Commitment

Are you able to attend the full retreat on the scheduled date? The retreat participation fee is $100 to help cover programming and meals. If selected are you able to submit the participation fee to secure your spot?

Additional Details

Is there anything else you would like us to know about your story to why this retreat would be meaningful for you?

Submit