Well Bound Retreats Intake Form

First name*

Last name*

Preferred Name

Email*

Phone (click the world icon to choose country code)*

Emergency Contact*

Emergency Contact Phone (click the world icon to choose country code)*

Are you sharing a room with a friend on this retreat?*

If you answered yes, what is their email address? (If you booked a bunk room, separate more than one email with a comma.)

Do you have any medical conditions we should be aware of?

Dietary restrictions*

None

Vegetarian

Vegan

Kosher

Gluten-free

Other

Accessibility needs or accommodations requested

What draws you to attending a book retreat?

Is there a book in mind that you plan to bring? If so, which one(s)?

What are your personal goals for this retreat? (e.g., rest, finish a book, deepen reading habits, connect with other readers)

Have you attended a book or creative retreat before?

Yes

Any concerns or questions you have before attending?

I understand that this retreat is a quiet, respectful, substance-free, and inclusive environment.

Yes

I agree to honor quiet reading hours and community guidelines.

Yes

I acknowledge that I am responsible for my personal belongings and well-being.

Yes

I have read, understand, and agree to the Terms & Conditions.

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