Retreat Health and Emergency Form

I’m truly Happy to walk this journey with you.

To ensure everyone’s safety and well-being, please take a moment to fill out this short form, which includes:

Full Name

Phone Number

Date Of Birth

Emergency Contact Full Name

Emergency Contact Phone Number

Their Relationship to You

Do you have any dietary restrictions or food intolerances?

Yes, Please Specify It Below No

Do you have any physical or mental health conditions we should be aware of?

Yes, Please Specify It Below No

Are you currently taking any medication?

Yes, Please Specify It Below No

Any allergies we should know about?

Yes, Please Specify It Below No