REJUVENATION MENS RETREAT We are looking forward to you joining us on this journey! Tell Us More About you… Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth MM DD YYYY Are you eligible for NDIS funding. YES NO Do you have any dietary requirements? Do you have any allergies? Do you have any physical or medical information that we need to be aware of that might impact your participation on the weekend? What are your hopes for the retreat? What brings you joy? Do you have a favourite scent or smell? ie Orange's, Popcorn, Marshmallows What is your favourite chocolate or sweet treat? ie. Dark, Rockyroad, Shortbread Please be advised that some images may be taken for use in marketing & social media. By agreeing to attend the retreat I give permission to use the images unless express written notification is provided. I am aware and accept the personal information provided is confidential and agree that what is shared by myself and other parties on the retreat is to remain confidential between those in attendance. I understand this is a Alcohol & Drug FREE Retreat * I agree Thank you for completing your form please return to the bookings page to complete your booking.Have a wonderful day.Warm RegardsThe Bear Haven
