Crieff Hills Retreat Registration Form

1
Name* This field is required.
First Name
Last Name
Pronouns
2
Contact Information* This field is required.
Phone Number
Email address
3
Where is the land you call home?* This field is required.
4
What are you hoping to gain from this experience?* This field is required.
5
Are you a part of any work or specific practices that are related to the content of this workshop?* This field is required.
6
I commit to practicing community care by testing negative for COVID before attending the retreat and understand that masks and other precautions are welcome.* This field is required.
7
How did you hear about this retreat?* This field is required.
8
What age group do you fall under?* This field is required.
18-25
35-45
25-35
45-55
55-65
65+
9
Please share your race, ethnicity, and any cultural identities that are meaningful to you.* This field is required.
10
Do you identify as LGBTQ+* This field is required.
YESNO
11
Do you identify as a person with a disability?* This field is required.
YESNO
12
Do you have any access needs you would like us to be aware of?* This field is required.
YESNO
13
Access Needs
14
Dietary Restrictions* This field is required.
Please Select
Vegan
Vegetarian
Gluten Free
Kosher
Halal
Other
None of the above
Please select all that apply.
Allergies, cultural needs, and anything else we should know
15
Please select your room preference* This field is required.All rooms have two (2) twin beds and a dedicated en suite bathroom. More information about Crieff Hills Retreat Center accommodations is available at this link. Accessible rate options are available.
Solo Room [SOLD OUT]
Shared Room
Commuter
16
Solo Room Sliding ScalePlease take a look at the breakdown below. On the next page, you will be asked to select your rate. You can use this tool to help identify where you might fall on the scale.
17
Shared Room Sliding ScalePlease take a look at the breakdown below. On the next page, you will be asked to select your rate. You can use this tool to help identify where you might fall on the scale.
18
Day Rate Sliding ScalePlease take a look at the breakdown below. On the next page, you will be asked to select your rate. You can use this tool to help identify where you might fall on the scale.
19
Sliding Scale* This field is required.Please select your preferred rate below. You can use this tool to help identify where you might fall on the scale.
I'll cover the cost of my attendance
I need a little help
I have a little to give
20
SOLD OUT! We're sorry, but the selection you made is no longer available.
21
How would you like to pay?* This field is required.If you need, you can break your payment up into two equal payments. The first payment is due today. The second payment will charge automatically in 30 days.
I would like to pay the full amount today.
I would like to break my payment up into two payments.
22
Do you require a room that is accessible from the ground floor?* This field is required.
YESNO
23
Would you like to share a room with a specific person?
YESNO
24
Roommate RequestPlease share the name of the person you would like to share your room with
25
Would you like to be included in communications about carpool arrangements?* This field is required.
YESNO
26
Emergency Contact* This field is required.
Name
Relationship
Phone Number
Email Address
Is there anything you would like us to know in case of an emergency? Pre-existing conditions, allergies to specific medications, etc.
27
Cancellation PolicyWe understand that circumstances can change. We've established the following refund policy to help us plan and deliver the retreat while remaining as fair as possible to all participants. – Cancellations received on or before October 19 will receive a full refund, minus a 20% administrative fee. – Cancellations received between October 20–31 will receive a 50% refund. – Cancellations received on or after November 1 are not eligible for a refund. All cancellation requests must be submitted in writing via email to assistant@wildbody.ca. Refunds will be issued to the original payment method and can take up to 10 business days to appear. Do you understand and agree to the terms outlined above?
YESNO
28
Is there anything else you would like us to know?* This field is required.
Should be Empty: