SayPro Registration Form A form to capture essential details such as participant contact information

SayPro Personal Development Retreat Registration Form

Thank you for your interest in the SayPro 5-Day Personal Development Retreat Camp. This form will help us gather essential information to personalize your experience and ensure we address your unique needs and goals during the retreat.

Please complete all sections to the best of your ability.

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Personal Information

1. Full Name
   (First, Last)
2. Preferred Name (If different)
3. Date of Birth
   (DD/MM/YYYY)
4. Gender
   (Optional) ☐ Male
   ☐ Female
   ☐ Non-binary
   ☐ Prefer not to say
   ☐ Other: _______________________
5. Email Address
6. Phone Number
   (Mobile or WhatsApp preferred)
7. Address
   (Street, City, State, ZIP Code, Country)

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Experience Level

8. What is your current experience with personal development or self-improvement?
   (Please select one) ☐ Beginner: I’m new to personal development practices and concepts.
   ☐ Intermediate: I have some experience with self-growth techniques and have attended workshops or read books.
   ☐ Advanced: I have been actively working on my personal growth and have participated in several personal development programs or retreats.
9. Have you ever attended a personal development retreat or camp before?
   ☐ Yes
   ☐ No

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Personal Development Goals

10. What are your main goals for attending this retreat?
    (Check all that apply)

☐ Increase self-awareness
☐ Develop better time management skills
☐ Improve emotional intelligence and resilience
☐ Set and achieve meaningful goals
☐ Find better work-life balance
☐ Build better relationships and communication skills
☐ Overcome limiting beliefs
☐ Other (please specify): _______________________________________

11. What areas of your life do you feel need the most improvement or attention?
    (Check all that apply)

☐ Career/Professional growth
☐ Personal relationships (family, friends, etc.)
☐ Emotional well-being and mental health
☐ Physical health and fitness
☐ Self-discipline and habits
☐ Spiritual growth and mindfulness
☐ Financial well-being
☐ Other (please specify): _______________________________________

12. What is one major challenge or obstacle you are currently facing in your personal growth journey?

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13. What would you like to walk away from the retreat with?

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14. What specific skills or tools would you like to gain or refine during this retreat?

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15. How do you typically stay motivated when working towards a goal?

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Health and Wellness Information

16. Do you have any medical conditions or dietary restrictions we should be aware of?
    (E.g., allergies, chronic conditions, vegetarian/vegan, etc.)

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17. Are you currently taking any medication?
    ☐ Yes
    ☐ No

If yes, please provide details: _______________________________________

18. Do you have any physical limitations or needs (e.g., mobility, vision, hearing)?
    ☐ Yes
    ☐ No

If yes, please describe: _______________________________________

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Additional Information

19. How did you hear about this retreat?
    ☐ Social Media (Facebook, Instagram, etc.)
    ☐ Word of Mouth
    ☐ Online Ad
    ☐ Previous Participant
    ☐ Other: _______________________________________
20. Do you have any questions or specific requests regarding the retreat?

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21. Why do you think this retreat is the right opportunity for you at this point in your life?

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Emergency Contact Information

22. Emergency Contact Name

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23. Emergency Contact Phone Number

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24. Relationship to Emergency Contact

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Consent and Agreement

By submitting this form, I consent to my participation in the SayPro 5-Day Personal Development Retreat Camp. I understand that the retreat will involve personal growth activities, workshops, and group exercises, and I agree to abide by the retreat’s guidelines and policies.

☐ I agree to the terms and conditions.

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Signature: _______________________________________

Date: _______________________________________

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Thank you for your registration! We look forward to supporting your personal growth and development during the SayPro Personal Development Retreat Camp. We will be in touch soon with further details.