Registration Form

Please fill out the following form complete the registration process and participate in our Wellness Retreat & Island Tours .

First name

Last name

Phone

Mailing Address

Emergency Contact Name & Phone Number

Any known allergies to food , medication or environmental factors? *

Yes

If you answered yes to the previous question, please elaborate

Are you suffering from a medically diagnosed health condition, illness or injury such as depression, anxiety, diabetes, hypertension, seizers, etc. *

Yes

List current medication & sleep aides.

Age group *

21-30

31-40

41-50

50-65

On a scale of 1-5 how active are you? One being not active at all & five being very active. *

Do you have any mobility limitations or issues walking or standing for more than 40 minutes? Please note, Paradise Divine Wellness Retreat & Island Tour will include low-moderate movement. *

Yes

Have you traveled to the Caribbean before? Please note that the temperature is humid. It's customary to greet each other by saying Good Morning, Good Afternoon & Good Evening *

Yes

What prompted you to sign up for our Wellness Retreat & Island Tour? What do you hope to gain from this experience?

Do you have any questions or information you'd like to share that wasn't covered in the previous sections?

What size do you wear in womens tops? This will ensure sizing accuracy for your Paradise Divine merch. *

Womens XS

Womens S

Womens M

Womens L

Womens XL

Womens XXL

I acknowledge that I am aware that Paradise Divine Wellness Retreat & Island Tour is a plant based vegan retreat. We will not serve or offer meat, poultry, seafood , dairy, egg or any animal byproducts. Please acknowledge you're aware that we will only serve & permit plant based meals on property.

I declare that the information I’ve provided is accurate & complete

I accept terms & conditions

Signature

Thanks for submitting!

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