JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Harvesting Wellness: A Fall Day Retreat
December 28th 930-4pm Lunch is included
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Crystalline Sounds, a Day Retreat
.
What is your name?
*
Your answer
Emergency Contact Information below.
*
Your answer
What is your phone number?
*
Your answer
Let's get to know you!
I would like to make your time at the spa day a great experience. Please fill out this questioner to help that. Thank you, Kathy.
Do you consider yourself an Introvert or Extrovert?
*
Introvert
Extrovert
What is your favorite lunch dish ?
*
Your answer
Are you allergic to anything?
*
Your answer
I will work with the group as a whole with a few dietary needs, here is what is available. The lunch will be served family style. There will always be a vegetarian and meat for the main course. Choose your diet.
*
Vegetarian
Vegan
Gluten-free
Dairy Free
Meat
Other:
If you have any concerns, please state them below:
*
Your answer
You must be willing to travel to the Deerfield location or any additional sites.
*
Yes
No
I understand that on the afternoon of the retreat, we are going to another destination. I have an option. Arrange a ride with another participant or use my own vehicle. Kathy will email you directions and details of a week prior to our day together.
*
Yes I understand
No I am confused
You understand you are responsible for your safety and well-being and waive all rights against Kathy Milanowski or her place of business, 119S Main Street Deerfield, Wisconsin.
*
Yes
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms