Better Gray Retreat Interest Questionnaire
Reflection & Renewal Wellness Retreat (Nov 7–8, 2026). This questionnaire is for adults 40+ who are genuinely interested in attending the Better Gray Reflection & Renewal Wellness Retreat (Nov 7–8, 2026). Your input will help us design an intentional and restorative experience. Please note: this retreat can only move forward with confirmed participant commitment, including the financial commitment and required deposit to secure your spot. All contact information is confidential and used exclusively for planning purposes.
What are your Top Wellness Priorities (select all that apply)
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Stress reduction
Mindfulness & meditation
Physical fitness
Nutrition & healthy eating
Emotional well-being
Rest & sleep
Connection with others
Personal growth
Nature immersion
Other
If you selected 'Other' for your wellness priorities, please specify:
Retreat Activities of Interest (select all that apply)
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Guided meditation and mindfulness
Yoga/stretching
Nature walks/hikes
Group discussions
Personal reflection time
Wellness education sessions
Journaling
Farm-to-Table Vegan Meals
Sound therapy
Intensive Breathwork
Herbal foot detox & reflexology
Guided Mini Facial & Face Yoga
Aromatherapy
Herbal exploration & Tea Tasting
Optional Upgrade Service: Elevated Facial ($175 extra)
Optional Upgrade Service: Elevated Traditional Massage ($175 extra)
Optional Upgrade Service: Thai Stretch Massage ($175 extra)
Dietary Preferences
*
Please Select
No preference
Vegetarian
Vegan
Gluten-free
Dairy-free
Pescatarian
Other
If you selected 'Other' for dietary preferences, please specify:
Do you have any food allergies or sensitivities?
*
Yes
No
If yes, please list your food allergies or sensitivities:
Mobility Level
*
Please Select
Fully mobile (no assistance needed)
Some mobility limitations
Require assistive device (cane, walker, etc.)
Wheelchair user
(Mobility & Accessibility Notice Please note: While we strive to create a welcoming and supportive experience for all guests, the retreat provider cannot guarantee that all retreat spaces, pathways, and activities will be fully accessible for individuals with mobility limitations or disabilities. We encourage participants with specific accessibility needs to contact us in advance so we can discuss available accommodations whenever possible.)
Accessibility Needs or Medical Considerations (please describe any accommodations or considerations for your comfort/safety)
Sleeping Arrangement Preference (Select one)
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Single bedroom, Micro-Suites, shared bathroom, $145 per night, per person
Shared bedroom & bathroom, Grand Cabin Double Room (2 people) $157 per night, per person
Single bedroom, Grand Cabin Private Room, shared bathroom, $269 per night, per person
No preference
All-Inclusive Price Selection-Please choose your preferred 2-day retreat package. The prices listed below represent the per-person cost for the full 2-day experience, including events listed in the retreat activity section, lodging, and meals.
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$1,700-Private Micro Suite room, all events listed in the retreat activity section, lodging, and meals.
$1,734-Grand Cabin Double room, all events listed in the retreat activity section, lodging, and meals.
$1,958-Grand Cabin Private room, all events listed in the retreat activity section, lodging, and meals.
Are you comfortable making an $800.00 deposit by Monday, March 2, 2026 to lock in this room rate?
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Yes
No
Maybe
Payment Preference
*
Pay in full
Deposit (1/2 full amount) now, remaining balance later
Payment plan (Klarna pay in four option)
Refund Policy AcknowledgmentPlease note that the retreat provider does not offer cancellations or refunds. If you are unable to attend, you may receive a credit toward a future stay or service, or you may choose to reschedule your visit for another available date.
*
I have read and understand the proposed refund schedule
What would make this the perfect retreat for you?
Interest in Attending (select all that apply)
*
I'm ready to register! Please email me the registration info.
I'm interested, but need more info or time.
I'd like to speak with someone.
Other
If you selected 'Other' for your interest in attending, please specify:
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Submit Questionnaire
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