Wilderness Retreat Questionnaire

General Information
Name *
Date of Birth *
Date of Birth
Emergency Contact *
Emergency Contact
Emergency Contact Phone Number *
Emergency Contact Phone Number
Do you have any dietary restrictions?
Gear & Logistics
What is your preferred sleeping arrangement?
What gear will you need? Check all that apply.
I can give you a sleeping bag if you would like. However, if you think you might go camping again you can get a pretty nice Colmans Sleeping Bag at Target for $30.
Part of this experience is going offline. Are you willing to keep your phone in airplane mode for the duration of the retreat? *
If this question is difficult for you to answer please refer to the retreat welcome page for information about going offline.
During the retreat I will be taking photos. What level of permission do you give for use of photos in promotional material?
Hopes & Fears
Please share whatever you are comfortable with. This question is so I can help support you throughout the weekend.
The following questions are to help me know you better. You do not have to be "outdoorsy" or a "mediator" to come on retreat. This is to help me know who is coming to the group and how to best support you during our time together.
What is your comfort level outdoors? *
What is your meditation practice like? *