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 rent 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.
Will you be able to make it to Joshua Tree by 12:30 pm Friday the 19th?
If you answer "no" or "not sure" to this question please e-mail me to figure out driving arrangements.
How would you like to make payment? *
The total is $500, you have given a deposit of $150.
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 guide 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