Retreat Application

Retreat Application + Agreement

Thank you for your interest in our transformative retreat. Please complete the information below as part of your application process.

Personal Information

First Name*:

Last Name*:

Birthday*:

Email*:

Phone Number*:

Emergency Contact

Emergency Contact Name*:

Emergency Contact Phone Number*:

Retreat Interest

Please describe your interest in this retreat:*

Experience

Do you have prior experience with meditation, sound healing, or nature retreats? Please describe:*

Where Did You Hear About Us?

Our WebsiteSocial MediaWord of MouthOther

If you selected "Other," please specify:

Health and Wellness Information

Do you have any dietary restrictions or allergies?*

Do you have any medical conditions we should be aware of?*

Are you currently taking any medications?*

Health History

Do you have a past history or currently suffer from any of the following?

Cardiovascular disease, including angina or heart attackHigh blood pressureAneurysmsMental illness or psychiatric hospitalizationSurgery (inpatient or outpatient)Infectious diseasesGlaucomaRetinal detachmentSeizure disorder (epilepsy)OsteoporosisBack injuriesSleep conditions (apnea, snoring)AsthmaPregnancyOther physical problems

If you answered "Yes" to any of the above, please provide more information:

Agreements

I understand this retreat is not a substitute for medical or mental health treatment.*

YesNo

I agree to follow all safety guidelines and instructions provided during the retreat.*

YesNo

Consent and Submission

By completing this form, you acknowledge that the information provided is true and accurate to the best of your knowledge. You agree to the outlined terms and risks of participating in the retreat.*

I agree

Signature*:

Date*:

Please prove you are human by selecting the cup.