Name
*
First Name
Last Name
Email
*
Phone
*
(###)
###
####
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Connection to Cancer
*
What is your primary circumstance that brings you to Creative Renewal Center?
Cancer Type & Stage?
*
Have you experienced a recurrence or metastasis? If so, please elaborate.
*
Preferred Experience
*
Select all that apply!
Preferred Activities
*
Select all that apply!
Visions, ideas, requests, restrictions, etc. We want to hear it all!
*
Hooray! You did it! Kudos to you for taking the time to answer our carefully curated questions so that we can ensure your experience participating is uniquely effective and empowering.
All workshop and retreat participants must complete this intake form so that our team can custom tailor the experience to uniquely accommodate the emotional energy and physical needs of each attendee, maximizing the transformative potential in a setting that is unconditionally safe for all stages of grief.
All community members (that includes you!) are encouraged to resubmit the intake form at any shift or turning point along the journey.
Come as you are, no strings attached. We appreciate your trust and vulnerability to create this safe haven for our community who so deeply deserves a healing space that is uniquely ours.
We are thrilled to welcome you to the Creative Renewal Center community.
Warmly yours,
The Creative Renewal Center Team
