Registration - Abaton Belize

Participant Information

Tell us a little about you. Fields marked with * are required.

Full Name

Date of Birth

Age

Preferred Name

Phone Number

Address

City

State

ZIP

Emergency Contact

Someone we can reach in case of an urgent health concern.

Emergency Contact Name

Relationship to Participant

Primary Phone

Secondary Phone

Medical History

Shared confidentially with the retreat team to keep you safe.

Primary Care Provider / Clinic

Provider Phone Number

Current medical conditions / diagnoses / injuries / concerns

Surgeries/hospitalizations in past 5 years?

If yes, describe

Mobility limitations / physical restrictions?

If yes, explain

Medications & Allergies

Include prescriptions, OTC, supplements, and herbal remedies.

Current medications / supplements / herbal remedies

Any allergies or sensitivities?

If yes, describe reactions & precautions

Food & Dietary Preferences

So our kitchen can prepare meals that suit you.

Food allergies / dietary restrictions / special meals

Other diet (if applicable)

Foods to avoid

Preferred foods / meal preferences

Caffeine use

Alcohol use

Retreat Goals & Wellness Intentions

Help us understand what's drawing you here.

Primary reasons for attending

What you hope to gain / improve / experience

Emotional / spiritual / wellness goals for the team

Consent & Acknowledgment

Please review and confirm before submitting.

I confirm that the information provided is true and complete to the best of my knowledge. I understand this retreat may include wellness, movement, mindfulness, nutrition, and other holistic activities, and that I am responsible for disclosing any condition that may affect my participation. I understand that retreat services are not a substitute for emergency medical treatment, and I should consult my licensed healthcare provider regarding my medical care. I authorize retreat staff to contact my emergency contact and seek appropriate assistance in an urgent health concern.

Signature (type your full name)

Date