Application Number

Which retreat date/location are you applying for? DO NOT submit more than 1 application.

Veteran First Name:

Veteran Last Name:

Veteran Gender:

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

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

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

Please indicate your current military service status:

Highest military rank (current or at discharge/retirement):

Number of Combat Zone Deployments ( at least 1 combat deployment ANYTIME during service is required for eligibility as we are grant funded to serve combat veterans)

Location and/or Mission for Combat Zone Deployment & year (ex, Desert Storm 1991, OIF 2004):

Veteran 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 CELL Phone (Please use dashes)

Veteran 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 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 can't accommodate dietary preferences or medical diets (ie, low sodium, insulin sensitive, vegan, keto, etc), ONLY FOOD ALLERGIES.

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 service member/primary 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/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 T Shirt Size

Support Person T Shirt Size

WITHIN 5 DAYS OF SUBMITTING THIS APPLICATION THE VETERAN 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 about your application*