Revival Grieving Mother's Retreat

A Note About the Retreat Application

We know your time is valuable, and we want to thank you in advance. While the application is somewhat lengthy, it should take approximately 15–20 minutes to complete. We've designed this process intentionally to help us better understand your needs, your story, and how we can best serve you during our time together. Our goal is to create a retreat experience that is not only meaningful but deeply personal and supportive. Your responses allow us to do that with great care. Thank you for entrusting us with your heart—we are honored to walk with you.

Please keep the following information in mind:

We understand the importance of your health needs. Our team will thoroughly review your application within 3 business days to ensure we can provide the necessary accommodations. If, for any reason, we are unable to meet your needs and you've already paid, we will promptly refund your registration fee. Your well-being is our priority. If approved, you will receive a welcome email.

If you are in need of a scholarship, please complete the scholarship application prior to registering for the retreat.

Mother's Information

Red Bird Ministries follows a strict confidentiality agreement. Only our RBM Team, the Assigned Small Group Leader, the Assigned Spiritual Director, and the Assigned Counselor are permitted to review your registration form. Please complete the entire registration form for registration.

I understand that my information below will not be share with anyone outside of the RBM team.

This address will receive a confirmation email

Health and Medical Conditions

The Red Bird Ministries team is not equipped to serve families with confirmed mental health diagnoses or families who are medically fragile. If you have a serious mental or health condition, please let us know before you arrive so that we can determine if our team can accommodate your needs.

Please let us know if you have any food allergies, including the severity, and how we can prepare food to accommodate you. In case of severe allergies, we may ask you to bring your own food if the retreat center cannot fully accommodate.

Do you have any food or environmental allergies we need to be aware of or sensitivity issues?

Are you under the medical care of a doctor with a medical or mental health condition that we need to be aware of?

Do you take any medications that may prevent you from participating in the retreat activities?

Please check if you have any of the following medical or mental health conditions.

The retreat center where we hold our retreat does require the retreatant to climb a short flight of stairs. Will you be able to climb the flight of stairs a few times over the weekend?

Yes No With minimal help.

Emergency Contact Information

Please provide the name and contact information of an emergency contact person who is aware of your attendance and will be available to be reached during the weekend in case of an emergency. Additionally, we will send out instructions by email on how to reach us during the retreat if something happens. Please ensure that they are aware and ask them to look out for the email.

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Email

This address will receive a confirmation email

What is your relationship to the emergency contact?

Age at Death. (If pregnancy loss, please list weeks in utero. This information is only used if we have to split a larger group into two groups to keep peers together.)

What were the circumstances surrounding your child's death?

We understand the importance of prayer, so please feel free to share a picture of your child or family here. We will use these photos to continue praying for you and your family.

Upload (8MB)

Church Parish + Diocese Information

What diocese + church parish do you worship in? Please list both diocese and parish.

If you are applying for a scholarship, please provide your parish phone number here.

Who is your pastor, or the pastor that has supported you in your grief? Please share if he serves as your current pastor or family friend.

Was it a good experience? Was your pastor grief informed? RBM is dedicated to providing education and training for clergy members. Please share any insights or information to help us serve them better. RBM will not share this information with anyone and will only use it to gather information to help educate and form clergy.

Familial Relationships

Are you married, seperated, divorced, or single?

Happily Married Married, but our marriage is not good. Single Divorced Seperated

Do you have any living children?

Yes No

If you have living children, how is your relationship with your living children?

Do you need a referral for your spouse or children for professional help, or would you like information about support for your family?

Grief Journey (Get to Know Me)

Please describe how you have been experiencing your grief (e.g. crying, insomnia, emotional numbness, health issues, etc.)

Please describe how you have been coping with the loss of your loved one? (ex: taking medication, praying more, praying less, seeking therapy, overindulging in drink/food, self-harm, etc.)

Have you sought help to address your grief? What was your experience with recovery? Were you comfortable?

Have you previously attended retreats, seminars, or conferences on grief? If so, please list and explain. What is your retreat experience, if any? What were the best parts of your retreat?

What are you hoping to gain from this retreat experience? What are you searching for? What does your heart desire most?

What is one thing you would like us to know about you as we prepare for this retreat? Please list any personality traits that may best help our leaders to serve you well.

Medical and Health Policy

Red Bird Ministries is not equipped to handle major medical or health needs. If an emergency arises and you must be taken to a doctor or hospital, we will need a copy of your health insurance card uploaded below.

If a retreatant requires medical care, contact your emergency contact. If you are from out of town, our volunteers will assist you in finding a walk-in clinic nearby.

If you need emergency medical care, RBM will call 911 on your behalf and someone will assist you to the ER.

Do you have health insurance?

Yes No

Upload Front

Upload (8MB)

Upload Back

Upload (8MB)

Red Bird Ministries is not equipped to handle medical or health needs.

If an emergency occurs and I need medical attention, I am responsible.

Communications Policy

Anyone who makes a purchase, or signs up for any event that we offer will be added to our newsletter email list. If you do not wish to receive any emails from us, please unsubscribe from the email list upon receiving your first email. This is an automatic process from our website platform.

I understand that I will receive newsletter event updates and support opportunities from RBM and if I do not wish to receive these further that I will unsubscribe and hold harmless RBM.

I agree to the communications policy.

I would like to share a hotel room with another retreatant to split the cost (dependent on availability)

Yes No

We hope to offer opportunities for Spiritual Direction and/or Counseling during the retreat. Are you interested in either or both of these sessions, if available?

Spiritual Direction Counseling Neither

Disclaimer & Retreat Policies

RBM's support seeks to accompany grieving families in the trenches of their grief but is not intended to replace traditional therapy. RBM does not provide online or in-person counseling or therapeutic services for a fee. Any registration fee, gift, or donation received directly offsets retreat center fees, operational, and program development expenses to fund these resources.

To simplify: The team of Red Bird Ministries and its volunteers are not mental health providers, and all retreatants will hold harmless the ministry and its volunteers for providing a safe place for you to bring your grief. If you need mental health counseling or have a mental health disease, please seek professional counseling. Our retreats and small groups are meant to be peer-led and support those who are grieving, but never to replace traditional therapy.

If you require counseling, please contact a licensed mental health provider in your area.

I agree and consent to the above statement and will hold harmless Red Bird Ministries in their efforts to accompany grieving families.

Yes, I agree.

Important Retreat Disclaimer

Please note that our retreat center requires us to meet 80% of our contracted commitment no later than 30 days before the retreat.

If we are unable to meet the minimum number of registered participants by that time, we reserve the right to reschedule the retreat. While we will make every effort to avoid this, unforeseen circumstances can arise, and we want to be transparent with our retreatants.

Please do not book flights or make non-refundable travel arrangements until you have received confirmation from our team that the retreat is confirmed to proceed. We will communicate clearly and promptly as we approach the 30-day mark.

Your healing is our priority, and we are committed to providing a peaceful, meaningful retreat experience. Thank you for your understanding and partnership as we plan and prepare.

With care,
The Red Bird Ministries Team

Revival Grieving Mother's Retreat - August 15-17, 2025

A Note About the Retreat Application

Important Retreat Disclaimer

Description

Revival Grieving Mother's Retreat - August 15-17, 2025

A Note About the Retreat Application

Important Retreat Disclaimer

Description

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