The Wilds Retreat Name * First Name Last Name Email * Phone (###) ### #### Date of Birth * MM DD YYYY Would you prefer a single or twin room? * Single Occupancy Room Twin Double Occupancy - same bed Triple Not Sure Yet Will you be travelling alone or with others? * Do you have any medical conditions? * Would you require any special access during this retreat? * Do you have any Allergies? * Yes No If yes, please provide details Have you been on retreat before? Yes No Unsure Where are you travelling from? Any other questions? Are you happy to be in any photos should they be taken? Yes I prefer not I will decide later on Thank you for filling out this form. I will be in touch if there is anything we need to discuss in more detail.
