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FASD Mom's Retreat Registration
Event Timing: November 3-5, 2023
Event Location: Dream Acres at Forest Park
Event Address: 3158 SE 10th Street; Topeka, KS 66607
Contact us at: 785-510-3016 or
info@dreamacresfasdcommunity.org
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Email
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Your email
Name
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Phone
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Address
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City
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State/Providence/Region
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Zip/Postal Code
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Country
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I am
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A mom to a child(ren) with an FASD (With a diagnosis)
A mom to a child(ren) with an FASD (Without an official diagnosis)
A female caregiver to an individual with an FASD
Mom's Retreat is being held at a semi rustic campground and attendees will be sharing a cabin, please share your top 3-5 choices for a roommate. We have cabins that can accommodate your larger groups as well!
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Because the retreat is being held at a campground, we ask that you bring your own bedding if possible. If you are flying in and need bedding, we have some available if requested. (Linen set will include bedding set and towel set)
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Yes, I need a linen set
No thanks, I don't mind bringing my bedding & towels from home
What 'craft/self care' session would you like to attend? These will be during Saturday afternoon
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Painting (this will be a small canvas project)
Succulent planting (You will decorate a pot and plant a take-home plant)
Jewelry Making
None, I'd rather enjoy connection, conversation, and community
Other:
Required
Dietary restrictions
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None
Vegetarian
Gluten-free
Other:
If you have any additional needs or accommodations, please let us know!
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Emergency Contact Name & Phone Number
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T-shirt size
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Choose
XS
S
M
L
XL
XXL
XXXL
Pay Registration
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$200 full Registration
Shuttle Service
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I am driving myself/with others $0
I need shuttle service from MCI (Kansas City) $20 (includes arrival & departure day)
I need shuttle from Topeka Train station $5 (includes arrival & departure day)
Other:
Donate to help another attend...
Donate $25 to help another mom attend
Donate $50 to help another mom attend
Donate $100 to help another mom attend
Donate $200 to help another mom attend
Other:
A copy of your responses will be emailed to the address you provided.
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