Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
EMERGENCY CONTACT DETAILS
Name
*
First Name
Last Name
Relationship to you.
Phone Number
*
-
Area Code
Phone Number
Address - if different to your address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
YOUR RETREAT DETAILS
Retreat Date
*
6th March - 10th March 2025
23rd May - 27th May 2025
9th October - 13th October 2025
Which retreat package would you like to experience?
*
Choose your package
Premium Indulgence (own bedroom and own bathroom) Valued at: $2,950pp
Indulgence Package (own bedroom, shared bathroom) Valued at: $2,650pp
Deluxe Package (twin share bedroom and bathroom). Valued at: $2,400pp - SOLD OUT FOR OCTOBER
So we can plan the first evening meal, what time do you intend to arrive on the first day? (You can update this closer to the retreat)
Before 7pm
After 7pm
Your package includes 60 mins of treatment. Please select from the treatment menu below to choose your treatment preferences.
60 min Bowen Therapy Treatment
60 min Massage treatment
Both treatments : 1 x 30 min Bowen and 1 x 30 min Massage
You have the option to add additional treatments and services to your package. Please select the additional treatment or services you would like to include from the list below:
30 min Massage - $50.00
30 min Bowen Therapy - $50.00
60 min Massage - $100.00
1:1 coaching session (discounted rate) - $100.00
HEALTH AND NUTRITIONAL CONSIDERATIONS
Do you have any nutritional preferences or requirements? Please select any / all that apply or provide specific details by selecting ‘Other’ and sharing further details.
*
NONE
Dairy Free
Gluten Free
Coeliac
FODMAP
Egg free
Vegetarian
Nut free
Vegan
Other
Are there any foods that you will not eat?
Please list any foods you do not eat above
Do you have any medical conditions?
*
Yes
No
If yes, please state your medical conditions below:
Are you currently taking any medications?
*
Yes
No
If yes, please state your medications below:
Do you have any current or pre-existing injuries that need to be considered for this retreat?
*
Yes
No
If yes, please state your injuries below:
How did you hear about The VitalityFit Retreat?
Google search
Facebook
Instagram
Word of mouth (friend or otherwise!)
Other
GUEST PARTICIPATION AGREEMENT
Special Offer Code:
Your discount will be confirmed in conjunction with your booking confirmation and applied to your balance payment invoice.
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