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Digital Detox Retreat                                                        23-26.11.2026 
Thank you for your interest in joining our retreat. Please complete this form so we can prepare the best possible experience for you.
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Full Name
Email Address
Phone Number (including country code)
Date of Birth
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Nationality
Country of Residence
Emergency Contact Name
Emergency Contact Relationship
Emergency Contact Phone Number
Do you have any medical conditions we should be aware of?
Do you have any allergies or dietary requirements?
Do you have any injuries or physical limitations that may affect your participation in activities such as stretching, hiking, or movement sessions?
Are you currently pregnant?
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Preferred room option
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Are you travelling with someone? If yes, please provide their name.
Will you require airport transfer?
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If known, please provide your flight details.
How did you hear about this retreat?
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I acknowledge that participation in retreat activities is voluntary and I take responsibility for my own health and well-being.
I understand that I should consult a healthcare professional before participating if I have any medical concerns.
I consent to being photographed during the retreat.
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I have read and agree to the retreat’s Terms & Conditions and Cancellation Policy.
Is there anything else you’d like us to know to help make your experience more comfortable or enjoyable?
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