Registration from - Womanity Portrait Foundation

WOMANITY PORTRAIT FOUNDATION REGISTRATION FORM _October 6-7 2026

General Registrant Information

First Name

Last Name

Phone/Mobile

Address

Apartment, Suite, etc.

City

State

Zip

Birthday

Update Your Information

Has your breast cancer diagnosis or treatment affected your ability to work?

Has your breast cancer created financial hardship for you?

Has your breast cancer impacted your household income?

Has your breast cancer experience increased your household expenses?

(Optional) Please feel free to elaborate on the financial impact of your cancer experience.

Marital Status

Single

Married

Divorced

Widowed

Date of your most recent diagnosis

(Optional) Year of your original diagnosis, if different from your most recent diagnosis?

Where are you as you navigate your breast cancer diagnosis?

What has been the biggest challenge you've faced since your diagnosis?

Why do you feel this retreat is important for you at this point in your breast cancer journey? (Please share what inspired you to apply and what you hope to gain from this experience)

Scholarship Request

Womanity Portrait Foundation offers three need-based scholarships for this retreat. Applicants requesting scholarship assistance will be contacted individually to discuss their circumstances in a confidential conversation.

Would financial hardship prevent you from attending the retreat without scholarship support?

Yes

Please briefly share what kind of support would make it possible for you to attend

Event Specific Questions

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

Do you have any dietary restrictions, food allergies, or special dietary needs? Please be as specific as possible.

Is this your first IN-PERSON event with Womanity Portrait Foundation?

Yes

Which Womanity Portrait Foundation programs or events have you participated in? (Select all that apply)

Are you currently taking oral chemo medication?

Yes

Will you require any medical assistance or monitoring during the retreat?

Do you have any physical limitations we should be aware of?

I understand that Julian Retreat Center is located in a remote area and emergency services may be limited

By checking this box I am acknowledging the statement above

Retreat Contribution Acknowledgment

I understand that if I am selected to attend the retreat, I will be asked to make a participation contribution to Womanity Portrait Foundation on a sliding scale of $150-$300 to confirm my participation. This contribution helps support the retreat experience and enables Womanity Portrait Foundation to make a charitable contribution to Whispering Winds Retreat Center. Three need-based scholarships are available for participants experiencing financial hardship. Applicants requesting scholarship assistance will be contacted individually to discuss their circumstances before scholarship recipients are selected. I understand that my participation contribution is non-refundable if I cancel fewer than seven (7) days before the retreat begins, as Womanity Portrait Foundation will have already committed those funds to retreat expenses and its charitable contribution to Whispering Winds Retreat Center.

By checking this box I am acknowledging the statement above

Waivers

Release of Liability!

I voluntarily participate with full knowledge that there is a risk of personal injury (including death), property damage, and/or other loss. On behalf of myself, my heirs, personal representatives, and executors, I hereby release, discharge, indemnify, and hold harmless Womanity Portrait Foundation, its subsidiaries and affiliates, and their respective officers, directors, employees, volunteers, and agents from and against any and all losses, liabilities, damages, actions, suits, demands, or claims of any nature or cause (each, a "Claim"), including costs and attorney's fees incurred by Womanity Portrait Foundation in connection with such Claim, arising from damages or injuries which may be sustained or caused by me, directly or indirectly, in connection with my participation with Womanity Portrait Foundation, whether or not caused by Womanity Portrait Foundation or its officers, directors, employees, or agents. By typing my name in this form, I agree that Womanity Portrait Foundation is in no way responsible for the safekeeping of any personal belongings while I attend Womanity Portrait Foundation’s events. My FULL LEGAL NAME here acts as my signature and acknowledgment of liability.

Full Legal Name (Signature)

Photo Release Consent*

I grant Womanity Portrait Foundation the right and permission in respect of photographic portraits, pictures or videos that it has taken, to copyright the same, in its own name or otherwise; to use, re-use, publish, and re-publish the same in whole or in part, individually or in any and all media now or hereafter known, and for any purpose whatsoever, for illustration, promotion, art, editorial, advertising and trade, or any other purpose whatsoever without restriction as to alteration.

For privacy reasons, I prefer not to be photographed or my picture used in any social media posts. I take responsibility to alert the staff and/or event photographer of my request. I will be mindful to keep myself out of group pictures.

Please Read Completely

Only applicants selected to attend the retreat will receive an acceptance email by September 18, 2026.
If you are selected, you must make your charitable donation within five (5) days of receiving your acceptance email, no later than September 23, 2026, to reserve your place.
Please email your donation confirmation receipt to galina@womanityportrait.org
If we do not receive your donation confirmation by September 23, 2026, your reservation will be canceled and your place will be offered to a participant on the waiting list.
If a space becomes available after the initial selection, applicants on the waiting list will be contacted by email or text.
Submitting an application does not guarantee acceptance, as space is limited.
If you have any questions, please email galina@womanityportrait.org

Check Your Understanding

I understand

I understand that this is an overnight retreat taking place October 6-7, 2026. If selected, I commit to attending the retreat for its full duration and staying overnight at Whispering Winds Retreat Center (Julian, CA) unless an emergency prevents me from doing so.

By checking this box I am acknowledging the statement above

General Registrant Information

Update Your Information

Scholarship Request

Event Specific Questions

Retreat Contribution Acknowledgment

Waivers

Release of Liability!

Photo Release Consent*

Please Read Completely

Be the first to know

Useful links

Navigations

Contact Details