dopwell retreat participant intake form

2025 Participant Retreat Intake Form

Secure your spot by July 30 to participate in an upcoming dopwell retreat in beautiful Saint Lucia this year. dopwell retreats, designed and facilitated by dopwell founder and certified coach Maria Dautruche, maintain a focus on post-experience integration - how the retreat informs and influences participants’ lives when they return home. Included in the price of dopwell retreats are the following: one 1:1 coaching session before retreat; meals; roundtrip airport transfers; daily on-site group activities including, learning circles, guided somatic exercises, cultural experiences, and excursions; and 3 one-hour group coaching calls to facilitate integration post-retreat.
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
At this time, dopwell retreats are for participants who identify as women. Stay tuned for an expanded retreat series in 2026. Do you identify as a woman?*

YesNoI prefer not to say.I'd like to speak more about this.
Date of Birth*

MonthDayYear
Date
How did you hear about dopwell and dopwell retreats?*
If other, please tell us how
Which dopwell retreat would you like to attend?*

Spacious Abundance: The Rest Practice invites participants to experience the 7 types of rest we all need to lead healthy and whole lives. (October 9-12, 2025)Spacious Abundance: The Power of Play invites participants to ignite joy and imagination through creative play and curious exploration (October 23-26, 2025)Pace of Purpose invites participants to experience a unique “workcation retreat” - truly experimenting with the possibility of harmonious integration of work and leisure through the practice of slow work. (November 3-6, 2025)Restful Reflection for Self-Growth invites participants to a calm and peaceful environment for self-reflection, healing, grieving, dreaming, and visioning rooted in personal values. (November 19-23, 2025) ONLY 2 SPOTS LEFT!!
Why are you interested in an upcoming dopwell retreat?*
Please briefly describe your previous experience with wellness retreats, coaching, or personal development.
If this is not applicable to you, please respond N/A.
The information below helps us best support your health and care during the retreat. Your responses directly impact final decisions on venues and activities. Please answer truthfully and to the best of your ability for your own safety.
Do you require any special accommodations?*

YesNo
Do you have a disability?*

YesNo
Please share more about your disability.
Do you have any other Medical Conditions?*

YesNo
Please list any medical conditions you have.
Do you require medical equipment?*

YesNo
Please describe your medical equipment.
Do you have any allergies (Seasonal, Medication, Food, etc.)*

YesNo
Please list these allergies and what happens when you have a reaction.
Emergengy Contact Information
Name*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Emergency Contact 2
Name*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*

Area CodePhone Number
More information about accommodations will be shared soon. In the meantime, please send your questions to mariaworkshere@gmail.com. You will receive a link to make your $500 deposit 2-3 days after we receive this form. You can also make your deposit through this form and secure your spot immediately!
Financial Agreement-1 - I agree to the full and final costs and deadlines given. Roomshare accommodations start at $1,850, and single deluxe accommodations range from $2,500 - $3,200, depending on retreat location and length. To secure my spot and schedule my 1:1 coaching call, my deposit of $500 is required. I understand that only when my $500 non-refundable deposit is received by dopwell group LLC is my spot to participate in a retreat secured.

YesNo
Financial Agreement-2 - Payment plans are available, and I understand that all funds are due one month before the retreat I am approved to attend. Furthermore, if I initiate a cancellation within 60 days of the retreat, any costs paid toward my retreat costs may not be refunded.

YesNo

Secure your spot now - Deposit Payment

dopwell retreat deposit$500.00

Total $0.00

Payment Methods

Credit Card

ACH Bank Transfer

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2025 Participant Retreat Intake Form

Payment Methods