Defence Wellbeing Retreat 2021
Application & Consent Form
Located at the Club Tropical Resort, Lee Point, NT.
Sessions start at 9am and run till approx 4.30pm each day, 28 Aug till Sunday 29 August.
Full Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Best Contact Number
E-mail
*
example@example.com
Emergency Contact Name:
*
Full Name
Emergency Contact Number:
*
Phone number
Posted Unit
*
ADF Unit
1. Are you Physically & Medically well? If no, Please specify below;
*
Yes
No
2. Can you participate in high intensity activities? (I.E Zumba) If no, Please specify below;
*
Yes
No
3. Do you have any medical conditions or injuries? If yes, Please specify below;
*
Yes
No
4. Do you have any allergies, intolerances or dietary requirements? If yes, Please specify below;
*
Yes
No
If required to specify more details, please provide below;
*Answering this question will NOT exclude you from the retreat, it will be used to guide retreat activities to suit the needs of each guest, where possible.
I will be available to attend as a
*
Day Guest ($49)
Overnight Guest ($79)
Which wellbeing topics interest you?
*
Rows
Not Interested
Somewhat Interested
Interested
Goal Setting
Mindfulness
Budgeting
Relaxation
Anxiety
Sleep
Fitness
Managing Change
Confidence
Meditation
Nutrition
Motivation
Burnout
Pilates/Yoga
Zumba
Other topics of interest to you?
Do you require childcare, If yes please list the children ages with a comma between each age;
How did you hear about this event?
*
Do you agree to be open minded during the retreat?
*
Yes
No
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Apply
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