NewBeing Queen BE YOU, BE ME, BE FREE, 2023 Royal Retreat Form

Welcome Queen, we are delighted to have you join us. We will have food, vendors pop up day, activities, tour the town, talent shows, morniing meditaion, games, and much more.

This is 4 nights and 5 day stay with the Queens

We will arrive Wednesday, AUGUST 9th and depart Sunday, AUGUST 13, 2023. If you come Thursday or Friday, your price will remain the same.

Once you make your first payment your spot will be reserved.

Every month after that is approximately $100-150. All funds are due no later than June 2, 2023.

The price does not include transportation to the location or price for the outing or shopping.

Food, bed space, activities are covered in the price. You may have to share room space.

THE FUNDS ARE NON REFUNDABLE

Thank you Queen

Full name*

First NameLast Name

Birth Date*

DayMonthYear

Address*

Street Address

Street Address Line 2

CityState

Post CodeCountry

E-mail*

Phone Number*

Emergency contact*

First NameLast Name

Emergency contact phone number*

Health Details

In order for us to best serve each participant on the retreat, please answer the following questions. All answers will be kept strictly confidential.

Rows	Yes	No
Do you have or have you ever had any physical health problems, eg. diabetes, epilepsy, high blood pressure?*
Do you have or have you ever had any mental health problems, eg: anviety, depression, PTSD?*
Are you now taking any prescribed medication?*
Are you now taking any of the following drugs: barbiturates, amphetamines, cocaine, heroin, hallucinogens?*
Do you have muscle or joint problem that could worsen by a change in your physical activity?*
Do you smoke?*

If you answered "Yes" to any of the questions above, give details of all occurrences. Include the following: dates, frequency, type, amount etc below

Do you have any dietary requirements/allergies?

If you have any questions that you wish to discuss prior to participating in the retreat, please do so before committing yourself to the program.

I realise that retreats held by NewBeing Queen Royal Retreats require my mental and physical health and I certify that I am fit to undertake it.

I understand there is non-refundable, and all funds are due by Friday, June 2, 2023.

Initials*

Thank you for choosing NewBeing Queen Royal treat as your place to kickback, relax and enoy yourself unapologetically.

NEWBEING QUEEN ROYAL RETREAT APPLICATION