Backpacking Retreat Questionnaire Name * First Name Last Name Preferred Pronouns Date of Birth * Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Is there anything about how you identify that you would like us to know? This could be in a traditional sense, like religion, race, sexual orientation, gender. Or, more general, like parent, artist or anything else you want to share about who you are. Medical Information Emergency Contact * First Name Last Name Relationship to Emergency Contact * Emergency Contact Phone Number * (###) ### #### Do you have any injuries or medical conditions? If yes please list below. * Do you have any allergies? If yes please list below. * Please list any and all medication you are currently taking. * Is there anything else health related that would be helpful for us to know about? Food Do you have any dietary restrictions? * Gluten Free Dairy Free Pescetarian Vegetarian Vegan None What do you like to drink in the morning? * Coffee Tea *With Caffein Tea *Herbal Other Are there any foods you don't like? Do you have any favorite foods while camping? Is there anything else that would be helpful for us to know about your diet or food preferences as we plan for the trip? Media During the retreat I will be taking photos. What level of permission do you give for use of photos in promotional material? You may use any photo I am in. You may use my photo as long as you cannot identify me. (Photos from far away or behind for example) You may not use any photo with me in it. Hopes and Helps Please only share what you are comfortable with. What do you find helpful as a facilitator? Are there any habits, patterns, or preferences that would be helpful to discuss? For example, preferring to teach in the morning or afternoon or other needs. What are your strengths as a facilitator? What are you working on as a facilitator? What are you most excited about with this upcoming trip? Is there anything else you would like us to know about you? What is a prayer or wish you are holding for yourself, others, the group as you lead this retreat? Thank you! Join the newsletter Subscribe to get updates on upcoming retreats, workshops and blog posts. Success! Now check your email to confirm your subscription. There was an error submitting your subscription. Please try again. First Name Email Address We use this field to detect spam bots. If you fill this in, you will be marked as a spammer. Subscribe We won't send you spam. Unsubscribe at any time. Powered by ConvertKit
