NURTURED BY NATURE Retreat Registration
Greetings! Thank you for taking the time to fill out this form.

If you have any questions, feel free to reach out via email to BeInspired@MaryInspireEvans.com

The next retreat is scheduled for OCTOBER 2025 in COSTA RICA.




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Email *
NAME *
BIRTHDATE *
Phone Number *
What kind of grief are you experiencing?
What are you looking to gain from this retreat?
What areas of your life are in need of empowerment?
Choose all that apply.
OCCUPATION *
Children?
Clear selection
This assessment provides an overview of effective strategies to maintain physical self-care. Using the scale below, rate the following areas in terms of frequency.  Please answer as honestly as possible.
5 = Frequently | 4 = Occasionally | 3 = Rarely | 2 = Never | 1 = It never occurred to me
5 | Frequently
4 | Occasionally
3 | Rarely
2 | Never
1 | It never occurred to me
Eat regularly (Breakfast, Lunch, Dinner)
Eat healthy foods
Exercise
Get regular medical care for prevention
Get medical attention when needed
Get Massages
Engage in fun physical activities (swim, bike, dance, etc.)
Take time to be sexual (with self or partner)
Get adequate sleep
Wear clothes that you like
Take vacations (including day trips or mini-vacations)
Take time away from technology
Take care of personal hygiene
Rest when you are not feeling well
Choose natural products in the store
Clear selection
This assessment provides an overview of effective strategies to maintain psychological self-care. Using the scale below, rate the following areas in terms of frequency.  Please answer as honestly as possible.
5 = Frequently | 4 = Occasionally | 3 = Rarely | 2 = Never | 1 = It never occurred to me
5 | Frequently
4 | Occasionally
3 | Rarely
2 | Never
1 | It never occurred to me
Make time for self-reflection
Write in a journal
Read literature unrelated to work
Make time to do something new
Intentionally decrease stress in your life
Spend time listening to inner thoughts
Engage your intelligence in fun activities (live performances, art exhibit, museum, etc.)
Practice receiving from others
Feed your curiosity for new ideas
Say "No" to extra responsibilities
Talk to someone about your negative thoughts (suicidal, self-harming, etc.)
Clear selection
This assessment provides an overview of effective strategies to maintain emotional self-care. Using the scale below, rate the following areas in terms of frequency.  Please answer as honestly as possible.
5 = Frequently | 4 = Occasionally | 3 = Rarely | 2 = Never | 1 = It never occurred to me
5 | Frequently
4 | Occasionally
3 | Rarely
2 | Never
1 | It never occurred to me
Spend time with others whose company you enjoy
Stay in contact with important people in your life
Give yourself affirmations/praise/pep talks
Tell yourself "I love you."
Re-read or Re-view your favorite books or movies
Identify comforting activities, objects, people, relationships
Allow yourself to cry
Find things that make you laugh
Express yourself in social actions, protests, marches, letters, etc.
Play with children
Speak to an elderly person
Clear selection
This assessment provides an overview of effective strategies to maintain spiritual self-care. Using the scale below, rate the following areas in terms of frequency.  Please answer as honestly as possible.
5 = Frequently | 4 = Occasionally | 3 = Rarely | 2 = Never | 1 = It never occurred to me
5 | Frequently
4 | Occasionally
3 | Rarely
2 | Never
1 | It never occurred to me
Make time for showing gratitude
Make time for spiritual practices
Find a spiritual connection or community
Experience being inspired
Greet your day with your optimism and hope
Bring awareness to nonmaterial/physical aspects of life
Release control or the need to be in charge of your life
Being open to the not knowing and embracing the unknown
Identify the things that bring meaning to your life
Meditate
Pray
Sing
Have experience of awe
Contribute to causes that you believe in
Read inspirational literature (talks, music, movies, etc.)
Clear selection
This assessment provides an overview of effective strategies to maintain professional self-care. Using the scale below, rate the following areas in terms of frequency.  Please answer as honestly as possible.
5 = Frequently | 4 = Occasionally | 3 = Rarely | 2 = Never | 1 = It never occurred to me
5 | Frequently
4 | Occasionally
3 | Rarely
2 | Never
1 | It never occurred to me
Take a break during the workday
Take time to socialize with co-workers
Make quiet time to complete tasks
Identify projects or tasks that are exciting and rewarding
Set limits with your clients and colleagues
Balance your workload to avoid becoming overwhelmed
Arrange your work space so it is comfortable
Get regular supervision or consultation
Negotiate for your needs (benefits, pay raise, etc.)
Have a peer support group
Invest time in a new idea/business
Research new information to assist you with elevating in the workplace
Strive for balance between home and work life
Strive for balance between work, family, and relationships
Invest money into a new venture or idea
Personally reach out to new clients/customers
Clear selection
What are 3 major goals you would like to accomplish?
What are 3 challenges that you frequently experience?
What is the most traumatic event that you have experienced as a child?
What is the most traumatic event that you have experienced as an adult?
What is the happiest moment you have ever experienced as a child?
What is the happiest moment you have ever experienced as an adult?
How is your relationship with FOCUS?
I strongly agree
I agree
Sometimes
I disagree
I strongly disagree
I tend to complete every task I begin
I complete tasks way before the deadline arrives
I am always on time
I multi-task while I am working
I work on multiple business ventures at once
I return important phone calls
I respond to emails/texts within 24hrs
I procrastinate on my work
I can work for long hours before needing a break
I require frequent breaks in between work
I write a To Do list for my goals
I remember things easily
I accomplish small goals before going after large ones
Clear selection
What is your love language?
Clear selection
What would you like to accomplish with your healing sessions?
Do you have any allergies? Please list them below.
Have you ever traveled outside of the United States?
Clear selection
Do you have a current passport?
Clear selection
What do you look for in a community or tribe?
A copy of your responses will be emailed to the address you provided.
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