Our Fire Collective Participation Interest Form

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**Due to COVID-19 all retreat dates have currently been postponed. Please fill out the following for when Our Fire Collective Retreats resume.** Thank you for your interest. Any honest input and personal information you provide will be used to determine best fit for an invitation to participate in collective healing, and will be kept private to the facilitators, guides, and logistics leads. We aim to set up group gatherings that will be safe for growth and collective work that will promote self love, collective care and challenge us to create change

Email *

Your full name (including preferred name) *

Phone number

How did you hear about this invitation to collective healing? Please give any names a shout out for shining a light your way about this opportunity. *

What is your race and/or ethnicity? *

Age *

Language(s) spoken: *

What school district(s) are you currently or have you previously been associated with? What were your roles? *

Please indicate what feels most like you *

Im excited and ready to be contacted for next steps forward

I am looking forward to being involved but I have a few questions

I am not sure how I feel yet please contact me with more information

Gender Identification *

Non-Binary

Woman

Man

Other:

What gathering are you interested in attending? *

Please contact me if dates become available before the fall of 2020

Other dates offered later in 2020 or beyond

Other:

Required

All groups are matched intentionally and with a priority on everyone to experience safety and bravery. Other than intentional caucuses, no groups will be majority male or white identified. Please give us an idea of your preference. *

I prefer an intentionally diverse group

I prefer a space that is with people of similar gender identity

I prefer to retreat with a group who all share my racial, ethnic, or cultural background

I prefer a group where participants are dealing with all the same topic/issues

No preference - up for any group deemed to match

Unsure/would want more info

Other:

Required

Do you have any disability or accessibility needs? *

All participants are expected to contribute financially and bring other resources to match the low cost of our offerings. One way to reduce individual cost is for one or two people on each retreat to take a planning/logistics role. Would you be interested to learn more about this option? *

Anything else you want us to know?

A copy of your responses will be emailed to the address you provided.

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