Embrace Retreat Registration Form
We need to know a few things about you. Our intention is to make the experience safe and inclusive where possible, and you are responsible for our own experience and safety. Please all fill out the form below. All held in strict confidence.
Name *
Your answer
Address *
Your answer
Email: *
Your answer
Phone No. *
Your answer
Next of kin contact info: *
Your answer
Do you have any experiences of similar personal growth events? Please say something about that. *
Your answer
Have you in the past or are you currently taking any form of medication? *
Your answer
Do you have any physical, emotional or mental health issues that would be useful for us to know about? *
Your answer
Please say something about why you are thinking of coming to this retreat. *
Your answer
What support/resources will help you integrate when you return home? *
Your answer
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