Mother Tongue: Participant Registration & Wellness Questionnaire
1. Personal Information
Name
First Name
Last Name
Gender
Male
Female
Prefare not to say
Email
example@example.com
Phone Number
-
Area Code
Phone Number
City/Town of Residence
Country of Residence
2. Emergency Contact
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
-
Area Code
Phone Number
Relationship to You
3. Physical Readiness & Fitness
Physical Readiness & Fitness
Low
Moderate
High
Are you comfortable participating in a guided hike?
Yes
No
Not Sure
Do you have any injuries or physical limitations? (If yes, specify)
4. Health & Wellness Information
Do you have any medical conditions? (If yes, specify)
Food allergies or intolerances? (If yes, specify)
Dietary Preference
Vegan
Vegetarian
Pescatarian
Omnivore
Other
5. Experience Logistics
(Given the nature of the experience and remoteness of the location, the date may be moved forward in the event of extreme weather conditions.) If the event is postponed or cancelled, would you prefer:
Full refund
Transfer booking
Would you like to join the Mongi Botanical mailing list?
Yes
No
How did you hear about the Mother Tongue experience?
Back
Next
6. Disclaimer & Participant Agreement
- Nature-Based Environment: You understand that the Mother Tongue experience takes
place in a natural, mostly untouched environment and is not a luxury experience.
- Participation in All Activities: You agree to participate in the scheduled activities to the
extent that you feel physically safe and comfortable.
- Environmental Respect: You commit to respecting the land, wildlife, plants, and all natural
elements during the experience.
- Photography & Content Creation: You consent to being photographed/recorded for
promotional content for Mongi Botanical.
7. Consent
I confirm that all information provided is accurate.
I acknowledge and accept the full Disclaimer & Participant Agreement.
I consent to the safe handling of my personal information.
Submit
Should be Empty: