LGBTIQ2 Youth

LGBTIQ2 Youth EcoHealing Retreat Registration
Saturday, June 25, 2022
9am-5pm
Beaverdam State Park
$100 Program Fee
Registration Deadline June 18, 2022

* Indicates required field

Preferred Name *

First

Last

Preferred Pronoun(s) *

Age (you need to be 13-18 years old to participate) *

Phone Number *

Email *

Parent/Legal Guardian Name *

First

Last

Parent/Legal Guardian Phone Number *

Parent/Legal Guardian Email *

Please indicate you have read and agree to the following statements by checking below: *

I understand the program fee is non-refundable. I understand the retreat is not group therapy. I will maintain group confidentiality. I understand that I will be expected to silence/store my phone throughout the retreat. I understand parental consent is required to participate.

By clicking below, you will be taken to our Donate page where you can submit the $100 program fee. After payment is received, you will be registered for the retreat. As we approach the retreat date, you and your parent/guardian can expect an email from us that will contain important preparation information. Thank you!

Submit & Pay

Phone: 434-466-8056​Email: [email protected]

Phone: 434-466-8056
Email: [email protected]