Retreat Waitlist Registration Form

Retreat Waitlist

Registration
Healing JourneyGirls' Trip
April 2025August 2025September 2025December 2025
Name*

First NameLast Name
Birth Date (Optional)

MonthDayYear
Email*
example@example.com
Phone Number

Area CodePhone Number
Social Media
(Optional: LinkedIn/ Instagram / Facebook/Website )
No RestrictionsGluten-FreePlant Based / VeganOther
Word of MouthInstagramFacebookQueen By Nature WellnessOther
What do you wish to achieve from your Wellness Vacay Experience, What are your goals, and/or expectations?*
What is your level of comfort when it comes to getting into the water? (pool/ocean/lagoon/river/cenote)*
Do you have any health limitations or physical injuries? Trouble walking? Please indicate if you have any major health issues (ex high/low blood pressure, arthritis, asthma, diabetes, seizures, osteoporosis, mental health concerns, etc.)*
Are you bothered by scents (essential oils, incense, perfumes etc.)? If yes, please let us know the details.*
Do you have any Questions or would you like to elaborate on the retreat experience you would like curated?
(optional)
Should be Empty: