Empowering Survivors With Accessible Retreat Opportunities

Because Every Woman Deserves the Chance to Heal

Financial Assistance

The founders of Healing Odyssey understand that active cancer treatment and resulting costs both for treatment and loss of ability to work often creates increased stress for the survivor and their families. We have been fortunate to have donors support us with funding.

Note that scholarships are only available for part or all of the Registration Fee. All transportation expenses are your responsibility and cannot be paid by Healing Odyssey.

E-mail us at registration@healingodyssey.org if you have any questions.

“Healing Odyssey has had a profound effect on my life as well as many others. I do not know any other program like this in the country. I am grateful that no woman is turned away due to lack of funds.”

Scholarship For Weekend Retreat

Required field must be checked before submitting form*
- I have read and understand the considerations above.*
Note: if you do not get a confirmation email after you register, your registration did not go through. Please call Healing Odyssey at 760-209-ODYS (6397) or email us at registration@healingodyssey.org.
IF YOU HAVE EXTREME NEED AND ARE UNABLE TO PAY THE FULL $200.00 FEE, PLEASE COMPLETE THIS FORM. Note that scholarships require a $25 non-refundable application Fee, with scholarships available for part or all of the remaining $175 Registration Fee. INFORMATION IS CONFIDENTIAL. Note that all transportation expenses (other than carpooling) will be your responsibility and will not be paid by Healing Odyssey. Also, if you are approved for a scholarship and you do not attend the current retreat, your application and scholarship will not be transferred to future retreats.
PLEASE CHOOSE ONE OF THE RETREATS BELOW
Select Retreat*
- HO 64 Apr. 23-25, 2027
Name*
First Last
First Name on badge*
Age
Birthdate
Home Phone
Cell Phone
Work Phone
Best number to reach you in the daytime
- Home
- Cell
- Work
Address*
Street Address Address Line 2 City State ZIP Code
Email:*
Enter Email Confirm Email
Type of financial Aid requested:
- Full Financial Aid ($175.00)
- Partial
Applicants are asked to pay what they can so that more women can be assisted. Even a $25 payment is appreciated.
Amount you feel you can afford.
Occupation (Current or Previous)
Work
- Full time
- Part time
- Unemployed
- Retired
If not employed, is this related to treatment for cancer?
- Yes
- No
How long have you been unemployed due to cancer treatment?
Are you currently collecting disability? Select all that apply
- State Diisability (SDI)
- Social Security Disability
- Company Disability
- Private Disability
- SS Income Disability (low income)
Marital Status
- Single
- Married
- Divorced
- Widowed
- Committed Relationship
Children?
- Yes
- No
How many?
Ages
Number of people in Family:
Monthly gross family income:
Please describe any other source of income:
Monthly gross family expenses:
Are other persons depending on your income:
- Yes
- No
If YES, who?
Additional justification
Do you have any other circumstances that create hardship such as lack of adequate medical insurance or other special circumstances
Affirmation please click on button*
- I affirm that the above statements are true and correct
Date
MM slash DD slash YYYY
Select T-Shirt Size
- S
- M
- L
- XL
- XXL
Emergency Contact Name:
Phone
Relationship
Date of cancer diagnosis
Type of Cancer
Surgery?
- Yes
- No
Chemotherapy?
- Yes
- No
Radiation?
- Yes
- No
Date of completion of treatment
If Breast Cancer: Reconstruction?
- Yes
- No
Completed?
- Yes
- No
When Completed?
Are you facing any other physical or emotional health challenges currently? If so, please describe:
Are you taking medications related to cancer treatment or other conditions? If so please list:
Do you have any life-threatening allergies? If so, please List:
What other challenges have you faced in your recovery?
Have you experienced any other major life events that are affecting you now?
What goals/expectations do you have for the Healing Odyssey retreat?
Do you have any dietary restrictions (Vegetarian, other)?
Do you have any special requests or concerns?
Ethnicity
Can you climb stairs?
- Yes
- No
Transportation is the responsibility of each participant. Carpooling may be possible. We will assist by giving your information on area drivers
Are you planning to carpool?
- Yes
- No
Arrangements already made with
Are you able to drive anyone?
- Yes
- No
How many people can you take?
(Just prior to the retreat, we will share names and phone numbers of women in your area. Your carpool group will then finalize arrangements between yourselves).
How, or from whom, did you learn of Healing Odyssey? Please be specific.
For example , the name and location if a support group
His/her name and address if a Professional
Other contact?
Please Note: The phone number for Pali Retreat is 909-939-0855. CELL PHONE COVERAGE IS AVAILABLE THROUGHOUT THE CAMP.
Application total for selected Retreat
$0.00
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name