Awaken Me Retreat Questionnaire Name * First Name Last Name Email * Phone number (###) ### #### Please provide the name of your emergency contact person below Please provide the phone number of your emergency contact person below (###) ### #### Which pronoun would you like us to use when we speak about you? (they, ze, your name, he, she etc.) How at home do you feel in your self right now? What connects you to your essence? What do you want to get out of this retreat? Do you have any medical conditions or take any medications that we should be aware of? Yes No If yes, please provide details below Are you attending this training with a partner or friend? Partner Friend Other You will be sleeping in mixed or same gender shared twin bedrooms within the lovely Quinta Catrinandes that are included in the cost of the event. Note - A very limited number of single rooms may be available for individuals at an additional surcharge. Do note that an application for a single room does not guarantee allocation of the room. Thank you for your understanding! Shared bedrooms Private room - I have read the note above Other Any specific accommodation requests? Please Note - While we will do our best to consider your request, it does not guarantee that we will be able to honour your request. Thank you for your understanding! Our chefs are interested in providing you with the optimum nutrition and healthy vegetarian meal options will be provided. Any special dietary requirements? Gluten intolerant Dairy intolerant Vegan Any other allerigies/intolerances? Any other special needs? e.g. mobility? How did you hear about our retreat? Thank you for filling this questionnaire! Any other things we would like us to know about you, please add here! Thank you! We look forward to seeing you at the Retreat!
