2026 Retreat Registration

2026 Details:

Dates: October 22nd-October 25th

Location: Loyola Retreat and Ecology Center, Woodstock IL

Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

This event is for currently practicing nature-based pediatric occupational therapists. Are you currently working with kids as a licensed occupational therapist or COTA outdoors in nature?*

Thank you for your interest in the Grounded to Grow retreat. This retreat is not for you this year. The Grounded to Grow retreat is for licensed occupational therapists/COTAs that are working outdoors with kids providing skilled, direct therapy services.

Name of the nature-based occupational therapy practice where you work *

Business website: *

Business Instagram link:

Business Facebook link:

Position in this nature-based therapy practice:*

Do you give us permission to publish your name, website, social media links, and email address in a Grounded to Grow Therapist Directory provided exclusively for G2G therapists that attend the retreat (it will not be published on a public platform or freely shared open source)?*

Please describe the pediatric nature-based occupational therapy work that you do.*

Emergency Contact*

First NameLast Name

Emergency Contact Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Do you have any health conditions, allergies, medications, or medical needs that the organizers or retreat center need to be aware of? Please detail any items that might impact safety, access and/or participation in an outdoor space, food exposure, medical attention, etc.*

Please list any food allergies or food preferences. This information will be shared with retreat center. Loyola has been accommodating to most all dietary needs and will again do their best to accommodate your food/dietary needs! *

Have you attended the Grounded to Grow retreat in the past?*

How comfortable are you speaking in front of a small group (< 10 people)?*

1 is Terrified, 5 is Confident

How comfortable are you speaking in front of a medium group (*

1 is Terrified, 5 is Confident

What topics are you hoping to learn or skills you hope to gain during this Grounded to Grow retreat?*

Due to time constraints, not everyone that attends will lead a session. However it is a community supported event so everyone will be asked to contribute in some way. Please check ALL ways you would be interested in supporting the retreat.*

Other ways you would like to support the success of this retreat

Topic*

Session Type (see info packet for examples)*

Session Category (your session can be an integration of all categories, but mark the one that best describes your session)*

Other

Is this a co-led session with someone else from your SAME business?*

If yes, which colleague are you planning this session with?

Describe your vision for this session. Include as much detail as possible!*

How much time do you want?*

Location Preference*

Do you anticipate wanting or needing use of technology for this session (projector and screen)?*

In the event that I am not able to give consent in an emergency requiring medical attention, permission is hereby given for the staff of Loyola University or any nearby retreat attendees whom are CPR/first aid certified to administer CPR and/or first aid as deemed necessary. Further permission is given to allow medical services to be performed by doctors, hospitals or other qualified medical providers as deemed necessary in an emergency, including surgery if reasonably necessary. I understand that the cost of all emergency services is my responsibility. Note: If you have any medical condition that the retreat organizers should be aware of it; is your responsibility to let us know of the existing condition prior to the start of the retreat. The information will be held in confidence and used only to render assistance should the need arise. Please check that you have read and consent to medical treatment, should it be needed.*

Informal photos and/or video-taping may be taken during the retreat and may be shared on attendees personal and business social media pages. Additionally, if we decide to host this retreat again in the future, these photos and/or videos may be used for marketing. Please indicate your preference regarding photo/video recording.*

LIABILITY RELEASE WAIVER AND AUTHORIZATION FORM. Participation at a Grounded to Grow retreat exposes participants to certain risks of being in the outdoors. Accidents and injuries resulting from the forces of mother nature, live animal and bug interactions, slipping and falling, malfunctioning equipment, unseen obstacles, fatigue, and your own and others’ misjudgment are very real possibilities. AFFIRMATION AND LIABILITY RELEASE. THE UNDERSIGNED CERTIFY THAT THEY AGREE AS FOLLOWS: 1. I hereby affirm that I have been informed that there are inherent dangers of being outdoors. 2. While all retreat participants are mindful of the space, accidents do happen. The undersigned(s) assume(s) all risk of injury or harm associated with participation in the retreat and agree(s) to release, indemnify, defend and forever discharge the retreat organizers and the retreat location, it's staff, employees, and agents of and from all liability, claims, demands, damages, costs, expenses, actions and causes of action in respect of death, injury, loss or damage to me, or by me, howsoever caused, arising or to arise by reason of or during my participation in the retreat. 3. I hereby agree to heed at all times the advice and instructions of the retreat organizers and the retreat venue and its owners to practice common sense while at this retreat. By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this retreat, I may be found by a court of law to have waived my right to maintain a lawsuit against the event organizers and the retreat venue on the basis of any claim from which I have released them herein. I have had sufficient opportunity to read this entire document. I have read & understood it, and I agree to be bound by its terms.

I have read and reviewed the above waivers and release of information. *

Grounded to Grow Registration DEPOSIT*

Grounded to Grow, 2026

Registration deposit. The remaining balance will be due in August 15, 2025. That balance is expected to range from $150-$200. Cancellation policy: cancel before August 1, 2026 to get an 80% refund of deposit. Cancel between August 2 and September 1, 2026 to get a 60% refund of all funds paid. Cancellations after September 1, 2025 are non-refundable.

$360.00

Transaction Fee

To process payments, we are charged 2.9% + $0.30 for each transaction.

$10.74

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Total

$0.00

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2026 Retreat Registration

Important Information for the Venue and Retreat Organizers

Community Contributions

Topic Proposal

Waivers & Release of Information