Belonging Without Performing

Complete this form so we can get to know you and prepare for our time together.

Full Name

Phone Number

City/State You're Traveling From?

What drew you to this retreat at this time?

What are you hoping to get out of this experience?

This is a no sex / no substances retreat. Are you willing to honor this agreement?

Yes

This retreat is a no-recording space. Are you willing to honor this agreement?

Yes

Do you have any dietary restrictions or preferences we should be aware of?

If you are in a shared room, are there any sleep preferences or needs you'd like us to consider?

Is there anything else you’d like me to know at this stage?

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