Just Us Retreat Registration 2024
We are excited you are interested in joining the Children's Brain Tumor Foundation at Happiness is Camping for the Just Us Retreat May 31-June 2. This conference is designed to give fathers a chance to meet and bond with other fathers, create memories with your child and have a great time! The information you provide on the application is confidential and will be used to ensure that we can accommodate the needs of all retreat participants. 
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Father's full name *
Relationship to survivor *
Best contact email *
Best contact phone *
Full address (street, city, state, zip) *
How many times have you attended Just Us? *
Do you have any special dietary needs? *
List any allergies for you. If none, put n/a.  *
List any physical limitations for you. If none, put n/a. *
What do you hope to get out of the weekend?
Are there any topics you would like discussed?
List some strengths and challenges of your relationship with your survivor child.  *
List an emergency contact and their information for you and your child (name, phone, email).  *
Full name of your child who is attending Just Us with you *
Child's date of birth *
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Child's gender  *
Contact email for child (if applicable)
Contact phone for child (if applicable)
Child's mailing address (only if different from yours).
Child's diagnosis *
Child's date of diagnosis *
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/
DD
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YYYY
Treatment center *
Your child is currently  *
List contact information for child's primary medical provider (name, phone, email). *
Does your child have any special dietary needs? *
List any allergies for your child. If none, put n/a. *
Fathers and children will be separated at times during the retreat, for discussions and activities. To ensure we have proper supervision, please answer the following questions about limitations and challenges as thoroughly as possible. Thank you!
Describe any medical concerns for your child that we should be aware of. If none, put n/a. *
Describe any physical limitations for your child that we should be aware of. If none, put n/a.
 *
Describe any cognitive challenges that we should be aware of. If none, put n/a.  *
Describe any emotional challenges that we should be aware of. If none, put n/a. 
 *
Retreat Logistics
The following questions will help us prepare for our weekend together. If your plans change and you are no longer able to join us, please let us know as soon as possible. Thank you! 
Father's shirt size *
Child's shirt size *
Fathers and children sleep in separate areas at the retreat (males and females each have designated areas). If you like, we can arrange for you and your child to share a room. Would you prefer to share a room with your child?  *
We play games and do activities throughout the weekend. Please let us know if you or your child has a talent they would like to share at the retreat (art project, singing/guitar for campfire, writing etc. If you provide information below, we will be in touch!
Arrival time is 5PM on Friday and departure is around lunch time on Sunday. Please indicate if you know you will not be able to arrive or depart at the designated time. If you are unsure, we will ask this question again. 
Thank you for applying for the Just Us Retreat. We will contact you within ten days of you registering. Space is limited but we will do our best to accommodate as many families as possible. Please contact Beth Jones at bjones@cbtf.org if you have any questions or would like additional information. We will be in touch soon!
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