SACRED SHE RETREAT FORM

First name

Last name

Email

Phone

Address

Emergency Contact Name

Emergency Contact Number

Instagram Handle

Health Questionnaire

Are you currently under the care of a physician for any medical condition? (if yes, please specify)

Have you every had any of the following medical conditions? (Check all that apply)

Are you pregnant (to the best of your knowledge) or trying to become pregnant?

Yes

No

Sleep Schedule

Im definitely

A morning person

A night person

Both are fine

Room Upgrade

By clicking this box, I am expressing interest in a potential room upgrade for an additional $200. Large master suite, shared room with private bathroom and terrace overlooking the red rock. (Subject to availability)

Meals

Please list any food allergies

Please list any OTHER (non food) allergies

Flights & Driving

If flying, do you require shuttle service from Phoenix airport to the retreat? (approx. 2-2.5 hour drive)

Yes

No

If you are flying, please indicate which city/country you are flying in from. We have a shuttle leaving at 2pm MT, otherwise your responsible for your travel. Consider buffer time for flight delays. (check phoenix time zones)

Incoming Flight (Airline + Flight Number)

Incoming Flight Arrival Time

Check out is at 10am sharp and shuttle will depart retreat arriving to the airport by 1pm. Please ensure you booked your flight later in the afternoon considering the above time.

Outgoing flight (Airline + Flight Number)

Outgoing flight Departure Time

If you are driving, please indicate the city you are coming from, and driving preference

I love driving alone

I would love to carpool

If you are wanting to carpool, please indicate which city you are driving from, and we will put you in touch with others wanting to also carpool if they are in your area.

I agree to getting mandatory travel insurance

I've agreed to the refund policy & liability waiver.

I understand this is a collective experience that all rooms and bathrooms are shared accommodation with the other retreat guests.

I understand this is a sober retreat and that no alcohol, cigarettes or drugs are permitted on the premise and throughout the retreat

Today's Date

Month

Day

Year

Signature

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