Pets N People

Health and Wellness

Holistic Therapy for Prevention and Amazing Healing

Nature's Divine

opening the door to nature

Melissa Bieber

320-267-8034

melissa@naturesdivine.net

Nature's Divine

opening the door to nature

Pets N People

health and wellness

Retreat & Class Reservation & Registration Form

Please complete this information form with Payment and Waiver and send it to:

Each Retreat/Class is limited in size. Registration is subject to availability.

Name: ________________________________________________________________________________

Age: _____________ DOB: ___________ Approx Height and weight: ______________________________

Type and session dates that you wish to attend: 1st choice:_____________ 2nd choice:________________

Have you previously attended a Retreat? _______  Do you have healing or holistic experience? __________

Do you have experience with horses? ______________Have you ridden before? ________

If yes, please describe your level of  experience: ________________________________________________

_______________________________________________________________________________________

Do you have any medical situation of which we should be aware? ______  If yes, please describe: ________________________________________________________________________________

________________________________________________________________________________

If a Minor: Names of Parents/Guardians: ________________________________________________

Address: _________________________________________________________________________

Address:  ________________________________________________________________________

Cell Phone Numbers: _______________________________________________________________

Home Phone Numbers: _____________________________________________________________

E-mail Addresses: __________________________________________________________________

Emergency Contacts Names: ________________________________________________________

Address: _________________________________________________________________________

Phone Number: ________________________ Phone Number: ______________________________

Special Interests and what you hope to experience with us: ___________________________________

__________________________________________________________________________________

How did you find out about us?__________________________________________________________

If you have special dietary or other needs - please bring what you need.

Signature (Parent/Guardian if Minor): ___________________________________  Date:____________

Thank you very much, we look forward to seeing you soon !!!