Retreat Application — Freely Rooted Podcast

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Out of respect for all parties involved, please only apply if you are 100% committed to coming:)

Name *

First Name

Last Name

Email *

Age *

Location: City, State *

If traveling to the retreat, what mode of transportation will you be choosing?

Flight + uber

Flight + rental car

Road tripping

How have you been impacted by the Freely Rooted message? *

What are most looking forward to receiving out of this retreat? *

Single? Married? *

Single

Single with kid(s)

Married

Married with kid(s)

Are you a nursing mother? If so, how old is your child? *

Are you an introvert or extrovert? *

I feel charged up by being around others

I feel charged up by being by myself

Do you have any food allergies? If so, please list: *

Are you comfortable receiving hands-on-healing & bodywork? *

I am here for all of it!

I prefer not to be touched

Are you trying to attend this retreat with friends? If so, please list names: *

Almost all beds on the property require to be shared. Are you comfortable sharing a bed with someone? *

Yes

No

Are you able to pay the $2700 in fulll? *

I can pay up-front

I will need to pay in installments

Thank you for applying!

Clearwater, FL

kori@rewildculture.com

Hours

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