Retreat Guest Profile | Abundant Roots Heali

First name

Last name

Email

Phone

Address

Emergency Contact Name

Emergency Contact Phone Number

Relationship

Do you currently have a passport

Yes

No

Currently applying

Passport expiration

Do you have any food allergies?

Do you have any medical conditions or physical limitations we should be aware of?

T-shirt size

Photography & Media Release Throughout the retreat photos and videos may be taken to capture special moments. Please select One

I give permission for Abundant Roots to use photos/videos of me for future promotional and marketing purposes.

I prefer not to appear in promotional photos or videos

Liability Waiver

I understand that participation in this retreat is voluntary.

I acknowledge that travel, physical activity, wellness practices, excursions, and outdoor activities involve inherent risks.

I assume responsibility for my participation and release Abundant Roots Healing & Wellness, its owners, employees, contractors, and partners from liability for injury, illness, loss, or damages except where prohibited by law.

I have read and agree

Retreat Policies Please review and acknowledge the following:

My $300 deposit is non-refundable

I understand the cancellation policy

I understand airfare is not included

I understand travel insurance is strongly recommended

I understand my reservation is not confirmed until all required documents are completed.

I agree to the Retreat Terms & Conditions

Is there anything you're celebrating or carrying with you that you'd like us to know? Examples might include: A milestone birthday, healing after a loss, career transition, personal growth journey

Which payment option are you choosing?

Paid in full

Monthly payment plan

If monthly payments: What day of the month would you prefer your recurring payment be processed?

Would you like us to use the same email address for invoices?

Yes

No

If no, please provide preferred email address

Payment Authorization

I understand that after paying my $300 reservation deposit, I will receive a recurring invoice for my remaining balance. Once I complete the first invoice payment, future payments will automatically process according to my selected payment schedule. I understand and agree.

Signature

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