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Jenny Mitich
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Retreat Intake Form
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Retreat Intake Form
Retreat Attendee Questionnaire
First Name
Last Name
Email
Phone/Mobile
Do you have any dietary restrictions or food allergies?
Emergency Contact Name
Emergency Contact Phone/Mobile
Do you snore?
Yes
No
Unsure
Are you comfortable sharing a room with a person of the same gender?
Yes
No
Do you have a preferred roommate? If so, write their name here
Can you go up & down flights of stairs? The retreat houses are four stories, but there is one bedroom on each building's ground floor that I am saving for those that cannot go up many flights of stairs.
Yes
No
How long have you been carnivore or animal-based?
- Select -
Brand new
Less than 6 months
6–12 months
1–3 years
3+ years
What are your primary health goals?
Weight loss
Metabolic health
Energy
Autoimmune support
Body composition
Community
Learning
Biohacking
Other
What are you most excited about at the retreat?
T-Shirt Size
- Select -
XS
S
M
L
XL
2XL
3XL
4XL
I understand retreat tickets are nonrefundable
Yes
No
Is there anything else we should know?
Submit Form
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