If you are attending one of our retreats please fill out the following form!

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_{All answers are kept confidential.}

I am attending the*

Winter Retreat

Summer Retreat

Fall Retreat

Name:*

First

Last

E-mail:*

Emergency Contact Name & Number:*

Food Allergies. (if yes, list below)

Any injuries or restrictions? (If yes, please list below)

I am interested in (you will receive a seperate email for any boxes checked)

massage (price not included in retreat ticket)

health coaching (free)

I give my permission to have my picture taken during the retreat:*

Yes

I give permission for my photograph to be used for Superior Retreats marketing (social media/website).*

Yes

I have read and understand the Cancellation/Inclement Weather Policies.*

Yes

Superior Retreats & Heartwood Conference Center are not responsible for any lost and/or stolen items during the retreat weekend. Alcoholic beverages will not be provided and only those 21+ can bring them. I acknowledge that I have been informed of the need to obtain a physician’s examination and approval prior to beginning this or any exercise program. I fully understand that the program may be strenuous and choose to participate completely voluntarily. I accept all responsibility for my health and any resultant injury or mishap that may affect my well-being or health in any way. I hold harmless of any responsibility, the instructor, facility, or any persons involved with this program or testing procedure.*

I understand

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If you are attending one of our retreats please fill out the following form!

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