Preferred Pronouns

Date of Birth

Age at date of your Baja trip

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

Relationship to Emergency Contact

Do you wear a MedicAlert tag?

Have you ever had a heart attack (coronary, thrombosis, myocardial infarction, etc.)?

Have you ever been told by a doctor that you have high blood pressure, heart murmur, or heart disease?

Have you ever experienced a seizure of any kind?

Do you experience anaphylactic shock from bee stings, other insect bites, or any food sources?

Are you allergic to any drugs, foods, or environmental substances? If yes, please list the severity of the allergy, the drugs you carry, and the symptoms of the allergic reaction.

Do you have any disabilities or problems with back, hips, knees, or ankles?

Are you currently taking any medications prescribed by a physician? If yes, please explain.

Would your doctor approve of your participation in this activity? If you cannot answer confidently, please consult your doctor.

Doctor name and phone number

Medical insurance provider and policy number.

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 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?

Logistics & Gear

Flight arrival into Loreto, Baja airport: Please provide date, airline, flight number, arrival time

If you do not know your flight info yet please make sure to add it to our logistics google doc as soon as you can.

Flight departure out of Loreto, Baja airport: Please provide date, airline, flight number, arrival time

If you do not know your flight info yet please make sure to add it to our logistics google doc as soon as you can.

Please list your double kayak partner's name (if relevant):

I am sharing a double tent with:

Height

Weight

Experience

The following questions are to help us know you better. You do not have to be an experienced kayaker or mediator to come on retreat, but we like to get an idea of where the group is at so we can plan the program accordingly and make sure you have the right kayak and gear.

Media

Hopes & Fears

Please only share what you are comfortable with.

What drew you to sign up for this retreat?

Imagine this retreat was deeply transformational, what would be different in your life three month from now? How about a year from now?

What is your biggest obstacle in life right now?

What is something you would like to let go of during this retreat?

What is one thing you would really like to practice over this retreat?

For example, being present, or letting go of expectations, or speaking up for what you need/want.

Being on retreat is a mix of alone time and time being with the group. Please describe your comfort level with both being alone and being in a group.

Do you have any fears about going on a kayaking camping retreat? If yes, what are they?

How can we best support you on this adventure?

What's something about yourself that you are excited to bring and share with other on this retreat? What's one of your strengths or gifts?

This can sometimes be a difficult question for people, but let it be simple and no need to find the perfect descriptions. It could be something like silliness, a sense of adventure, knowledge, vulnerability etc.

Is there anything else you would like us to know about you?

Baja Retreat Questionnaire

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