Balance & Bliss Retreat - L'Image Parfaite Day Spa

Retreat Application Form

Join our retreat on March 8th and 9th, 2025

Personal Information

Full name* DOB*

Gender* Contact Number*

Email* Address*

Emergency Contact

Full Name* Relationship*

Contact Number* Alt. Contact Number

Health and Diet Information

Do you have any dietary restrictions or allergies? (If yes, please specify) Do you have any medical conditions we should be aware of? (If yes, please specify) Are you currently taking any medication? (If yes, please specify)

Retreat Details

What attracts you to this retreat?* Please share your motivation or goals: Have you attended a retreat before?* (If yes, please provide details)

How did you hear about us?* Preferred attendance*

Do you require any special accommodations? (If yes, please specify)

Additional Information

Please share any additional information you think is relevant for us to know:

By submitting this application form, I acknowledge that completing the form and selecting my package (One Day or Weekend Pass) does not guarantee participation in the Balance & Bliss Retreat.