Pre-Retreat Form

Name

First Name

Last Name

Phone

(###)

###

####

Accommodation Choice

If you’re attending with a friend, please let us know their name below so we can room you together.

Food Preferences or Dietary Needs

Do you have any allergies or sensitivities we should know about?

What do you most wish to receive from this retreat?

What word or feeling describes how you want to leave the retreat?

Have you experienced a cacao ceremony or somatic movement before?

Is there anything we can do to help you feel especially comfortable or supported during your stay?

Emergency Contact Name & Number