retreat intake form

Wellness Retreat Intake Form. Please complete every required section so our team can prepare a safe, supportive, and personalized experience.

First name*

Last name*

Email*

Phone*

Address*

Tell us a little about yourself, your daily life, and anything you would like us to know.*

What are you hoping to gain, explore, or feel during this retreat?*

Yoga experience*

Fitness experience*

Wellness practices explored

Meditation

Breathwork

Mindfulness

Massage or bodywork

Nutrition

Energy work

None yet

Other

Health conditions, medications, injuries, pain, mobility considerations, or other relevant health information.*

Restrictions, triggers, sensitivities, allergies, or activities you need to avoid.*

Modifications, props, pacing, accessibility support, or accommodations needed for safe participation.*

Emergency contact details*

Emergency contact relationship*

Dietary requirements

Vegetarian

Vegan

Gluten-free

Dairy-free

Nut-free

No restrictions

Other

Food allergies or intolerances.*

Arrival and departure details, including approximate times if known.

Travel or accommodation requests and notes.

Photo and video preference*

I confirm that I have disclosed relevant health conditions, injuries, limitations, allergies, and restrictions, and will notify the team if anything changes.

I confirm that the information provided is accurate and understand it will be used to prepare appropriate support and modifications for my retreat experience.

PRANA + PLAY

info@pranaandplay.com

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