Name of participant *

First Name

Last Name

Which, if any, apply to the participant? *

ADD

ADHD

Anxiety

PTSD

Grief

Stress

Self Esteem

Anger management

Depression

Other

None

Name of caregiver *

First Name

Last Name

Contact phone number of caregiver *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Caregiver Emergency contact *

Name

First Name

Last Name

Emergency contact phone number *

(###)

###

####

Please confirm you have read and agree to the following terms.

All bookings must be paid in full in advance

Bookings are non-refundable, please get adequate insurance.

Please complete a Covid-19 test the morning of the retreat

The group may not go ahead in very strong winds, due to the dangers of falling branches, also if the numbers are low. We will give you as much notice as possible, but we recommend getting insurance to cover accommodation and travel expenses in case this happens.