Name
First Name
Last Name
Email
*
Phone
Country
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Full Address (street, city, zip code, country)
*
Date of birth
MM
DD
YYYY
Please describe the gender identity that best describes you and share your preferred pronoun(s) (optional)
Please share anything you wish about who you are, how you identify, where you’re from, your background (optional)
Emergency contact (name, relation, phone number)
What are your intentions for this retreat? (optional)
Are there any challenges, fears or blocks you hope to address during the retreat? (optional)
Which parts of the retreat program (see brochure) resonate most with you, and are there any parts you feel hesitant about? (optional)
N O U S is a co-creative space. Do you have any gifts/skills you would like to offer and share with the group? (optional)
Our host Mas Vilalte follows a "no meat" and completely organic policy. All meals will be vegetarian and mostly locally grown. Please let us know about any dietary preferences (i.e. vegan, glutenfree) or food allergies.
Do you have any medical conditions we should be aware of (e.g., diabetes, heart conditions, epilepsy, etc.)? Have you had any recent surgeries, injuries or illnesses? If yes, please elaborate.
Do you have a history of severe allergies or anaphylaxis? If yes, please elaborate.
Are there any physical or emotional conditions we should be aware of to ensure your physical and psychological safety and a comfortable participation in the daily schedule of the retreat (including activities like meditation, yoga, sharing circles, nature-based practices)? If yes, please elaborate.
Are you currently taking any medications that may affect your participation? If yes, please elaborate.
Do you have any mental health conditions or challenges that we should consider to support your retreat experience?
Are you currently using any prescribed medications for a mental health condition? If so, please confirm that you will continue your treatment throughout the duration of your retreat.
Have you recently, or in the past, suffered from any mental health challenges, such as depression, anxiety, bi-polarity, self-harming or suicidal tendencies? If yes, please elaborate.
Are there any additional factors concerning your current life circumstances of which you would like to inform the N O U S Team, or feel it would be helpful for us to know? (optional)
Are you happy to be added to a Signal group before the start of the retreat with the purpose of coordinating logistics and transport?
If you are contributing on a sliding scale (between € 250 - € 1900), please let us know which amount you are able to contribute (if you are paying the full rate, please ignore this question):
After submitting this form, you will receive an invoice. Please select your preferred payment plan:
Do you need a VAT invoice for your organisation/employer? If yes, please provide all necessary data for the invoice. (optional)
HEALTH AND SAFETY: I acknowledge that I am responsible for my own health and well-being during the retreat. I understand that participation in activities is at my own risk and that I have disclosed all relevant health information.
HEALTH AND SAFETY: I agree to inform N O U S of any physical, mental or emotional condition/s that could impact my participation in this retreat, e.g. injuries, chronic conditions, recent medical or surgical procedures, any medication/s taken.
HEALTH AND SAFETY: I agree to waive N O U S from any liability from any physical, mental or emotional conditions arising during or after the retreat.
LANGUAGE: I understand that the retreat is held in English and I am comfortable following and participating in English (most of us in the N O U S team are non-native English speakers).
MEDIA CONSENT: I consent to the use of photos/videos taken during the retreat for N O U S website and social media.
TERMS AND CONDITIONS: I have read and agree to the retreat's Terms and Conditions, including payment and cancellation policies (see link in the website footer below).
