Held Retreat Application

First Name

Last Name

Date of Birth

Email Address *

Phone Number

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

What draws you to this immersion?

Have you done any previous self development or growth work?

Have you taken retreat before? If so what kind?

Do you have your own therapist or supports from professionals?

What do you do to look after yourself?

Do you have any diagnosed mental health conditions or physical health conditions that would prevent you from exploring and wandering in nature?