SHIFT In-Person Intensive Interest Form

Please fill out the following fields and we will be in touch shortly.

Yes

Personally seeking support

Condition of divorce proceedings

Condition of child custody proceedings

Condition of Diversion or DPA agreement

Condition of criminal sentence

Another reason

My lawyer

Word of mouth

Internet search

BIP Provider list

Other

Weekend Group Intensive

5-Day Group Intensive

Private 3-Day Intensive

Private 5-Day Intensive

Not sure yet, I have questions.

Yes, I'm open to this

No, I prefer private programming

The small-group rate would apply if your programming is a group experience.

I understand that program fees must be paid in full prior to the start of programming.

*Cancellations made 30 days or more prior to the start date of the retreat will receive a full refund. Cancellations made less than 30 days before the start of the retreat will receive a 50% refund. No refunds will be provided for no-shows.

I understand that there is an expectation that I will stay at the retreat center for the duration of the program, or commit to participating in all programming throughout my program's duration.

I understand that I'm responsible for the full cost of services, even if I decide not to partake in lodging or provided meals.