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IWA Registration Form
Island Wellness Cumberland Adventure Oct. 31 & Nov. 1, 2023 Two night Event (departure Nov. 2)
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Email
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Today’s Date:
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Name:
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Phone #:
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Date of Birth:
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Would you like to receive updates, newsletter, specials via email?
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Emergency Contact Name & Number:
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Describe any injuries/conditions you might have (use back, if necessary):
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Are you physically fit?
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How far can you walk?
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Are you able to easily get on and off of a boat and in and out of the back of a pickup truck?
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Do you have any food allergies or take any medicines which we should be aware of or which interact with certain foods?
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