WILD & BLOOM RETREATS

Retreat Booking Form

Thank you for booking with us. Please complete the details below so we can prepare fully for your time with us.

PERSONAL DETAILS

Full name

Phone

Emergency contact — name and number

Dietary requirements

Anything we should know to support you fully? (Optional)

TRAVEL & LOGISTICS

Expected arrival time

Time

HoursMinutes

Transport needs

HOPES FOR YOUR RETREAT

Is there anything you're hoping to get from this time away? Optional — shared with your facilitators ahead of the retreat.

CONSENT & AGREEMENT

I consent to photography/video being taken during the

retreat for marketing purposes.

I have read and accept the cancellation policy.

I have personal travel insurance.

I have read and accept the liability waiver / terms

and conditions.

Signature

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Date

Day

Month

Year

Rooted in nature. Held with care. Designed to restore. Immersive retreats led by a fully qualified psychotherapist.

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