Name *

First Name

Last Name

Preferred Phone Number *

(###)

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Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

Country

(###)

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T-Shirt Size *

X-Small

Small

Medium

Large

X-Large

XX-Large

XXX-Large

Medical Background *

Great

Good

Fair

Poor

Are you currently on any medication? *

Yes

No

Are you affected by any of the following? *

Heart Problems of Any Type

Glaucoma

Arthritis/Bone or Joint Problems

Neck Injury

Low Blood Pressure

Headaches

Back Injury

Asthma

Diabetes

Carpal Tunnel Syndrome

High Blood Pressure

Detatched Retina

Chronic Pain

Knee Injury

None

Have you recently...

Sought therapy/counseling

Attended physical therapy

Had surgery

Become pregnant

Our preferred retreat hotels are Margaritaville Vacation Club by Wyndham & St. Thomas and Point Pleasant Resort St. Thomas. We have organized daily transportation to and from these two locations. If you choose to stay elsewhere on Saint Thomas, you will be required to organize your own transportation to and from one of these properties before daily departure and after daily drop off. Failure to be on time for daily pick up may result in you missing out on one or several group activities and if you plan on not showing you are required to notify Gabrielle Leonard or a member of her team as soon as possible. Failure to notify us of an absence could result in expulsion from the entire retreat. *

I agree

For your comfort, wear comfortable clothing and dress in layers. Although Saint Thomas is tropical, we may be in locations that can get chilly. We would also suggest either a small blanket or shawl. Please bring comfortable walking shoes. *

I agree

You contribute to the experience. Please refrain from wearing perfume or other strong scents to class. Turn off cell phones or make them completely silent, in other words no vibration. Remove shoes at the front door before entering the house. Be on time to workshops. If you intend to miss a workshop, please email gabrielle@gabrielleleonard.com. Refunds or credits towards other workshops or retreats will not be offered. *

I agree

You are responsible to make us aware of any medical conditions or physical concerns you may have in general and on the day of your workshop. Please also advise of any food, essential oil, or other allergies. We will offer guidance and accommodations based on this knowledge. It is your responsibility to keep yourself safe and injury free. Use your own wisdom and knowledge of your body to adjust during your participation. You always have a choice. You decide what’s right for you. *

I agree

Any and all outstanding payments and balances due to Gabrielle Leonard must be fully paid and settled before your participation in this retreat. This includes payment plans that are scheduled to conclude after the retreat. Failure to settle all outstanding balances before the retreat start date could result in you not being allowed admittance to the retreat or any related activities at Gabrielle Leonard's discretion. *

I agree

Date *

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