**Grounded Intention Registration Form**

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Please fill out this questionnaire and pay your deposit to save your spot for the retreat! Please note: this retreat is for women & femmes only.

First Name: *

Last Name: *

Email Address: *

Phone Number: *

Do you identify as a woman or non-binary femme? (woman includes trans women)

Yes

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What brings you to Grounded Intention Retreat? *

I'm feeling burnt out and need a break

I had a busy summer and am ready to slow down

I've got a lot on my mind and want to gain clarity

I want to kickstart my winter wellness

I need some me time before the holiday season

I just wanna get cozy with some cool people

You said there's a sauna in the house?!

I'm healing from a hard life experience and need support

I'm trying something new

Other:

Required

Do you have any food allergies or eating restrictions? Please list all below or write "none" if you have none. *

Are you allergic or sensitive to any ingredients found in bath and body or beauty products? Please list all below or write "none" if you have none. *

Which accommodations are you interested in? *

My own bed in the big shared room, slumber partyyy!

Sharing a bed with my friend or lover or family member (save $25 each)

Is it possible to get my own room? (the answer is maybe for an extra cost...)

IF YOU ARE SHARING A BED, who do you plan on sharing with?

Do you have any questions about the retreat or need special accomodations?

Once Gigi receives your response to this questionnaire, she will send you an email with payment options. Thank you so much for taking the first step towards nourishment, rejuvenation and restoration at Grounded Intention Retreat!

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