Costa Rica Retreat w/ Awake & Soulful LLC
Contract, Agreement & Waiver
Email address *
First Name *
Last Name *
Phone Number *
Home Address (Please Include the Country You Reside) *
Date *
MM
/
DD
/
YYYY
Emergency Contact Name *
Emergency Contact Phone Number *
Emergency Contact Relation *
Passport ID Number
Please check the box below if you DO NOT have your Passport yet, but WILL send Passport info to Gina & Elyse as soon as you acquire it.
Which bed/room selection do you choose? *
Do you have any special dietary needs? If so, please share below.
Do you have any mental or physical health conditions that we should be aware of before participating in this retreat?
Is there anything else you'd like to add?
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