Retreat Guest Information:
Hold your place with a simple deposit —we can't wait to welcome you.
Today's Date:
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Month
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Day
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Date
Contact Name
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First Name
Last Name
Mailing Address
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Street Address
Street Address Line 2
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Billing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Format: (000) 000-0000.
E-mail
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example@example.com
Emergency Contact Name
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First Name
Last Name
Emergency Contact Phone Number
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Format: (000) 000-0000.
How did you hear about us?
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Facebook
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Previous Retreat
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Other
Are you a mom or currently pregnant?
*
Please Select
Yes
No
If you are pregnant, what trimester will you be in on the retreat?
Please Select
First
Second
Third
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Which payment plan?
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Please Select
None - paying in full
Private Room payment plan
Shared Room payment plan
Please select any of the following dietary restrictions/preferences?
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Vegan
Vegetarian
Pescatarian
Dairy-Free
Gluten-Free
Kosher
Nut-Free
Shellfish allergy
None
Other
To help us personalize your spa experience, do you have a preference for a male or female massage therapist during your 50-minute classic massage?
*
Please Select
Yes, I prefer a female
Yes, I prefer a male
No either option is fine
I understand that all payments made toward Off Duty: A Mom’s Retreat are non-refundable due to the nature and planning requirements of this retreat.
*
Please Select
Yes
I confirm and agree that all payments for Off Duty: A Mom's Retreat will be paid in full by April 1, 2027
*
Please Select
Yes
May we use photos/videos we take of you on the retreat on all of our social media platforms and website?
*
Please Select
Yes
No
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My Products
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Private Room – Your Own Sanctuary - Deposit
$500.00
$
500.00
Quantity
1
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Shared Room – Rest, With Gentle Company - Deposit
$500.00
$
500.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
First Name
Last Name
Paying Client
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