October 22 Humble Warrior Day of Wellness Retreat
This is the registration form required to attend the Humble Warrior Day of Wellness Retreat on October 22 in Jackson County, Georgia. This retreat is open only to women veterans and women first responders. You are not fully registered until we have received this form, your payment, and you have received a confirmation email from us. If you have any questions about this or other Humble Warrior offerings, please email us at info@humblewarrior.org 
Sign in to Google to save your progress. Learn more
First Name *
Last Name *
Preferred Name or Nickname (how would you like us to address you at the retreat)
Pronouns
email address *
phone number *
Mailing address (please include your full address including city, state, and zip code, as well as any apartment or suite numbers/letters) *
Emergency Contact Full Name (first and last) *
Emergency Contact relationship to you (neighbor, spouse, sister, friend, etc.) *
Emergency Contact phone number *
Select your status *
Have you attended a Humble Warrior Retreat before? *
If "Yes" to the above - when was the retreat you attended? - If "No" to above - please write "no" *
T-shirt size *
Do you have any dietary accommodations? *
Do you have any lifestyle accessibility accommodations that are needed to attend this retreat? (ex: stairs or terrain may be present at this location) *
What appeals to you about this wellness retreat? *
How will this retreat help you fulfill your personal goals? *
Do you have any special wellness skills or resources that you would like to share with the group? (example: essential oils, massage, etc.)
Do you foresee a financial hardship covering costs of transportation to and from the retreat? If so, please briefly explain in "other" - scholarships are available on a case by case basis - you will receive a follow up email if you select "other" to discuss the possibility of a scholarship *
I agree to sharing accommodations during the Humble Warrior Wellness Retreat (this includes bathrooms and shared common rooms) - all required health and safety precautions will be in effect *
After you submit your registration, you will receive instructions to pay your $20.00 fully refundable registration fee to complete your registration. The fee will be forfeited and considered a donation if you choose not to attend. Information about our cancelation policy will be included in the email. *
In the event that the registration list is filled at this time, would you like to be added to the Wait List to be notified if a space becomes available? *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms