Sisterhood Retreat Registration Form

Name

First NameLast Name
E-mail
example@example.com
Phone Number
Do you want to share a room? If yes how many do you want to be in the room including you?
How many days are you interested in attending?

Checking in Friday - Leaving SundayChecking in Thursday - Leaving Sunday
How far are you willing to travel?
What is your trip budjet? (Keep in mind, do not include any personal spending cost)

$350 - $450$475 - $550$600 - $775$1000 + above
Are you afraid to fly?
Do you have any food allergies? If yes, what are they?
Do you have a food preference?

OmnivorePescetarian (only fish as a meat source)Ovo-lacto vegetarian (Consumes dairy and eggs)Vegan
What are your reasons for participating in this retreat?
What do you expect to get from the retreat?
What activities are you interested in doing?

Walking for exerciseJournalingVision Board & WineMeditationSpa (you are responsible for the additional cost)Mock PhotoshootLine DancingBible Trivia
If you dont see something you consider fun or that interests you, tell us about it below.
Physical/Psychological/Health Condition
In this section, please highlight any physical or health condition that applies from the options below. This will help us make sure you are suited for the retreat.
Do you suffer from any of the following:

low blood sugar / hypoglycemiaschizophreniaAngina/Chest PainArthiritisAsthmaCancerCirculatory ProblemsChronic PainEpilepsyDiabetesHigh Blood PressureHIV / AIDSLow Blood SugarMigrainesObesity
Do you suffer from any of the psychological conditions?

Attenton Deficit DisorderAttention Deficient Hyperactive DisorderAutism (any diagnosed spectre)Asperger'sBipolar DisorderBorderline Personality DisorderChronic AnxietyDiagnosed DepressionEating DisorderMultiple Personality DisorderObssesive Compulsive DisorderPanic AttacksPeranoiaPost-Traumatic Stress DisorderSchizophreniaSelf - HarmSuicidal Ideation / thoughts / attemptsNoneOther
Are you currently taking or have your been prescribed any medications for any of the above psychological conditions? If so, please briefly describe below
Are you currently taking or have you recently stopped taking anti-depressant medication?
Have you ever been diagnosed, treated, or self-identified with drug addiction/abuse?
If so, please provide us with some additional information about the types of drugs, date(s), or time span of addiction and your experience of any therapy or rehabilitation you have undergone to heal.
Retreat Waiver:

I acknowledge that I am voluntarily participating in the retreat organized by Thee Blueprint Collective. I understand that the retreat may involve physical activities, and I am aware of the potential risks associated with such activities. I hereby release Thee Blueprint Collective and its organizers, and any associated personnel from any liability for injuries or damages that may occur during the retreat.

I understand the importance of following safety guidelines and instructions provided by the organizers. I agree to abide by these guidelines to ensure a safe and enjoyable retreat experience.

In case of any injury or medical emergency, I authorize the organizers to seek medical attention on my behalf. I also understand that I am responsible for any medical expenses incurred during the retreat.

By signing below, I affirm that I have read, understood, and voluntarily agreed to this waiver.
Print your name below.
Signature

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Date

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Date
Emergency Disclosure:

In the event of an emergency, please contact the following person:
What is your emergency contact name?
What are they relationship to you?
What is your emergency contact phone number?
Type a question
I hereby grant permission for Thee Blueprint Collective to share my medical information with emergency medical personnel if necessary. Please print your name below.
Signature

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Date

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Date
Should be Empty: