Sunrise Grief Retreat Society Registration Information Form

Thank you for taking the time to complete this detailed questionnaire.  This will provide us with the necessary information so that we can offer you the best quality experience possible.  All information will be considered confidential and will only be shared with group facilitators.


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Date of Retreat for which you are applying
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Your name
Your address
Your telephone
Your Email
Your birthdate
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Emergency contact name and number
Please provide some details about the person for whom you are grieving including the date and cause of death.  Are there other losses you are also grieving?
Have you received any professional help for your grief?
Have you received any other help, such as participation in a support group?  If yes to either of these questions, was it beneficial OR has your grief become more difficult to deal with in any way?
Are you currently being treated for significant depression or anxiety, panic attacks, post-traumatic stress disorder, or other psychiatric disorders?  If so, please provide a list of medications.
Apart from your present grief, please list any other major stresses, life changes or losses you are currently dealing with in your life.  (e.g. medical illness &/or treatments, relationships, finances, other)
Please list the three things you most look forward to during the Retreat:
Do you have any fears or anxieties about the Retreat?  If yes, please be specific.
Shared room accommodation may be necessary.  Does this present a problem for you?
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Is there anything else we should know to ensure that you are comfortable sleeping at the Retreat Centre?
If flying, are you able to provide your own transportation to the Retreat venue from the Kelowna Airport?
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How did you hear about the Retreat?
We have a policy that there is to be no alcohol or recreational drugs (including cannabis) consumed during the Retreat.  The reason for this policy is that any mind altering substance may interfere with the process of your grief work during the Retreat.
I have read and agree with the cancellation policy on the registration page
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