Spiritual Summer Camp Retreat Intake Form
We are so excited you are joining us for Spiritual Summer Camp!

Please fill out this form as honestly as possible. We want to make sure we have all the information about your health to protect your safety and well-being throughout the program and retreat. We are always here to answer any questions you have and help make sure you have everything you need, so please email Sinclair at sinclair@sinclairfleetwood.com if you need support. 

Can't wait to see you family!

Sinclair, John, and Elaine
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Hi, what's your full name? *
Email Address *
Date of Birth *
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 Please describe your current state of health. *
Please indicate if you have a history of any of the following health conditions: *
Required
Please share anything additional you would like us to know about your physical health. *
Please check any of the following psychological and emotional health conditions that you are currently experiencing or have experienced in the past: (Please note that having one or more of these conditions does not necessarily mean you can't participate in our program. We review each person's experiences on a case-by-case basis to make a final determination.) *
Required
Please share more details about your psychological and emotional health here. *
 Are you currently taking any medications? Please list all pharmaceutical drugs, herbs, vitamins, supplements, how much you take and for how long. *
Have you had any medical procedures or surgeries in the last year? If so, please elaborate. *
 Are you pregnant? *
Is there anything else you would like us to know about you? *
Do you have any dietary restrictions? Please let us know here. We will be offering a healthy menu aligned with the best practices for the medicines, and will do our best to accommodate your needs.  *
Do you need help or are you able to offer help with transportation to the venue? (Carpool from Asheville, shared ride if you're driving, etc.?) *
Do you need help finding gear or can you offer/share extra camping gear? 

Let us know what you need/have you can share with others. *
Can you bring firewood and/or ice? If so, let us know here. We need a lot of wood especially, so everything helps! *
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