Return to Self Retreat 2027 Form

Return to Self Retreat 2027 Registration Form

Dates: April 30 – May 4, 2027

Location: Mizata Antiresort | Playa Mizata, La Libertad, El Salvador

Hosted By: Au Naturale Spa & Wellness with Elizabeth Rodriguez

Participant Information

Full Name *

Date of Birth *

Phone Number *

Email Address *

Address *

Emergency Contact Name & Relationship *

Emergency Contact Phone Number *

Room Selection

Select Your Room *

Preferred Roommate(s)

Payment Options

A non-refundable deposit of $500 is required to reserve your space.

Payment Plan *

Preferred Payment Method *
ZelleCredit CardCashOther

Health & Wellness Information

Medical conditions, injuries, allergies, or dietary restrictions we should be aware of?
[textarea health-conditions placeholder "Please describe any relevant health information..." class:rf-textarea]

Are you currently pregnant? *

Please list any medications currently being taken:
[textarea medications placeholder "List any medications you are currently taking..." class:rf-textarea]

Liability Waiver & Agreement

By signing below, I acknowledge and agree to the following:

1. All retreat payments are non-refundable.

2. If participant cancels or chooses not to attend the retreat for any reason, a cancellation penalty equal to 35% of the total retreat cost is due because of resort accommodations, excursions, transportation, and reserved experiences.

3. Au Naturale Spa & Wellness is not responsible for injuries during retreat activities or excursions including the Tamanique Waterfalls excursion.

4. Participation in retreat activities and excursions is voluntary and participant assumes all associated risks.

Participant Name (Print) *

Participant Signature *

Date *

I have read and agree to the Liability Waiver & Agreement above.