Retreat From Cancer
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Welcome
Donate
Retreat Guests
SCOTT'S STORY
Q&A
Retreat Guest Application
*
Indicates required field
Name
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First
Last
[object Object]
Email
*
Phone Number
*
Address
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Line 1
Line 2
City
State
Zip Code
Country
Do you prefer a specific city?
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No, I'm flexible
Yes, Please see list of preferred cities below
Cities
*
Do you have any dates in mind?
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No, I'm flexible - any weekend
No, I'm flexible - any days
Yes, I would prefer the following dates
Please note we need at least 1 month in advance to coordinate. Vacation Rental Donations are typically 2 nights
Dates
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Type of Cancer
*
Bladder Cancer
Breast Cancer
Colon/Rectum Cancer
Endometrial Cancer
Kidney Cancer
Leukemia
Lung Cancer
Melanoma
Non-Hodgkin Lymphoma
Pancreatic Cancer
Prostate Cancer
Thyroid Cancer
Other
Treatment Staus
*
Currently in treatment
Finished with treatment
Taking a break
Other
Additional Question/Comments/Preferences?
*
Please be sure to list any other preferences you may have (by lake, ocean, mountain, 3 bedrooms, no stairs..)
Rolling applications will be accepted throughout the year. Retreat Guests may also need to fill out a rental application, that depends on rental home you choose. Priority is given to those who are currently undergoing treatment, then to those who have finished. Please note all our vacation homes DO NOT allow large parties/celebrations, each rental has different maximum number of occupants allowed.
Submit
Please note: Once your
Retreat Guest Application
has been received, we may request additional documents such as medical release form and/or copy of last treatment appointments.