Application Number

Which retreat date/location are you applying for? DO NOT submit more than 1 application, INCLUDING if you & spouse/support both served - Only 1 application per pair is needed.

Veteran/First Responder First Name:

Veteran/First Responder Last Name:

Veteran/First Responder Gender:

Branch of Service. Note: You may select more than one answer below.

Approximate Start of Veterans Military Service/First Responder Service (YYYY,MM,DD)  Use pop up, do not type manually.

Approximate End of Veterans Military/First Responder Service (if still serving list today's date) (YYYY,MM,DD)  Use pop up, do not type manually.

Please indicate your current military service/First Responder status:

Highest military rank (current or at discharge/retirement). First Responders put N/A:

Military Only: Number of Combat Zone Deployments

Location and/or Mission for Combat Zone Deployment & year (ex, Desert Storm 1991, OIF 2004). First Responders put N/A:

Veteran/First Responder E-mail Address * VETERAN: Check your SPAM/JUNK folder within 5 days of submitting this application and search for email from retreats@gratitudeamerica.org *

Veteran/First Responder CELL Phone (Please use dashes)

Veteran/First Responder Date of Birth (YYYY,MM,DD)  Use pop up, do not type manually.

Home Address

City

State  *NOTE: We cannot help with transportation & it's not included in program. We provide lodging, meals, & activities*

Zip Code

What is your current relationship status?

Name of Primary ADULT support person you are bringing to retreat.  (Service Member cannot attend alone  and children are not permitted)

What is your current role/relationship with person coming to retreat with you?  (Service Member/First Responder cannot attend alone  and children are not permitted)

How many years have you known your Primary Support Person?

Support Person E-mail Address

Support Person Phone (Please use dashes)

Please select any of the following health concerns that you

Please provide any additional information about the health concerns you described above or other info about any health concerns, even if not listed above:

Please describe any physical limitations you have and any assistance/accommodations you will need during the retreat

Do you or your support person have any food allergies? NOTE: We make our best effort to accommodate food allergies, however if you have food allergies. We recommend to meal prep/bring your own food. WE CANNOT GUARANTEE THE CATERED FOOD WE PROVIDE IS ALLERGEN FREE.

Do you have a service canine? Any participant who has their service canine attend retreat are REQUIRED to bring crate/kennel

Are you or your support person currently participating in any of the following treatment or support groups (select all that apply):

Have you attended any previous retreats for service members/First Responders and/or your families? (describe)

What do you hope to gain from participating in this retreat?

How did you learn about our Military Support Retreats?

Do you have a hotel room preference?

Veteran/First Responder T Shirt Size

Support Person T Shirt Size

WITHIN 5 DAYS OF SUBMITTING THIS APPLICATION THE VETERAN/SERVICE MEMBER WILL RECEIVE AN EMAIL FROM RETREATS@GRATITUDEAMERICA.ORG   Check your SPAM/JUNK folder on day 5 after submission and search your email for that address. If you do not see our email anywhere in your boxes or folders, your application did not successfully submit - please re submit.  Have you read this message?

Retreat is for adults only & childcare isn't provided. Hotel, meals, & activities are provided, we CANNOT assist with transportation. Does this work for you? *IF YOU SELECT NO, WE WILL NOT CONTACT YOU*

PLEASE READ: If you have attended previously, we will ONLY contact you if we have spots available after all applications have been reviewed. Priority is for those who have never attended. You will not hear from us unless we have openings available for past participants, regardless of how long ago you attended. Did you read this message?