Booking Form and Deposit                                 (Costa Rica March 30- April 6, 2024)
You will be asked for payment upon completion of this form. A $500USD non-refundable deposit is required to complete your booking.
Sign in to Google to save your progress. Learn more
Choose your Room *
Participant Information *
First and last name
Participant Email *
First and last name
Participant Information (Address) *
Participant Information (Phone Number) *
Participant's Date of Birth *
Roomate Request (Name) if Double Occupancy?
Dietary Request (if none please write N/A *
Medical conditions/Concerns/Allergies? *
Emergency Contact (Name, Email, Phone number) *
How did you hear about us?
Terms & Conditions *
Required
Our Cancellation Policy is as follows:

If you cancel your booking 90 days before the retreat (Sunday Dec. 31, 2023) start date your deposit (less $959 CAD, $700 USD, or €656 EUR depending on the currency of your retreat) and other payments may be transferred to another CentrePhysicianWellness (Healing the Healer) trip (within two years of current retreat), space permitting. If you cancel your booking less than 90 days before the retreat start date all monies paid will be forfeited. Trip cancellation/trip interruption insurance is strongly recommended.

In the event that the trip is postponed for any reason, including any force majeure event, all monies paid will be converted into travel credit that can be applied to a future CentrePhysicianWellness trip; this credit is transferable and expires two years from the original retreat date. CentrePhysicianWellness is a small business that proudly works with intimate, family-run hotels and venues and we are unable to offer refunds of any kind. If you require more security, please talk to an insurance broker about a comprehensive travel plan that will offer you the coverage you need. Thank you for understanding.
*
Required
Referred by (Name) *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Irina Mihaescu. Report Abuse