Return To Flow: A Soul Immersion By The Sea
February 19-22, 2026
St. Augustine, FL
Name
1 FIRST NAME
LAST NAME
2. Where are you traveling from?
3. Is this your first retreat?
4. What drew you to this retreat?
5. Briefly explain your spiritual/wellness experience? (no experience is needed)
6. What do you hope to receive from this retreat?
7. Is there any specific medical/injury information we should know that will help us best accommodate you?
8. Do you have any dietary/ food requests or allergies we should know about?
9. If You Are NOT an Existing Client Or Retreat Attendee Of The Joyful Shaman/Naomi Pareja, Please List Days/Times Available To Set Up A Zoom Meeting With Naomi. She Will Email A Link To Confirm Meeting Date.
PARTICIPANT CONTACT INFO
NAME
ADDRESS
PHONE NUMBER
EMAIL ADDRESS
example@example.com
Instagram Account (if you have one)
Facebook Account (if you have one)
EMERGENCY CONTACT INFO
PRIMARY CONTACT NAME
RELATIONSHIP
ADDRESS
PHONE NUMBER
ALTERNATE PHONE NUMBER
EMAIL ADDRESS
example@example.com
SECONDARY CONTACT OPTIONAL
RELATIONSHIP
ADDRESS
PHONE NUMBER
ALTERNATE PHONE NUMBER
EMAIL ADDRESS
example@example.com
Submit
Should be Empty: