Retreats Gateless Retreat Participant Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.In preparation for our upcoming Connecticut Coast Retreat from October 18-21, 2025, please provide details on food sensitivity, health challenges, ER contacts and the like. Included is also our Release and Cancellation Policy. You cannot participate in retreat without completing the form. Participant Contact DetailsPlease provide your full contact details and the best way to reach you during the retreat.Name *FirstLastEmail *Phone Number *Participant ProfileBio *Please provide a short bio, where you are from, what you have done or are doing for work and how you found out about Gateless.Photo * Drag & Drop Files, Choose Files to Upload Selfie or casual photo is fine. Upload your photo here (accepted file types: .png, .jpg, .tif, .gif, and .doc. 3 MB max file size). Any difficulty, contact gatelessacademy@gmail.com. Emergency Contact DetailsIn the event of an emergency, please let us know who we may contact.Emergency Contact Name *FirstLastEmergency Contact Email *Emergency Contact Phone Number *Food SensitivitiesTo help us plan catering, please let us know if you have any food sensitivities we should be aware of.Do you have any food sensitivities? Please explain. *What do you like to put in your coffee (milk or non-dairy choices)? *Travel ArrangementsWhat time do you plan to arrive at the Retreat in CT on October 18?What time do you plan to depart on October 21?Health Challenges Mental Health: Please note: these are very important. Not revealing mental and physical health challenges is against the Gateless Writing Program Policy. These allow us to assist our writers and keep them as safe as possible in their experiences.Do you have any mental health challenges that we should be aware of? If so, please explain below so that we know how to best support you. *Please advise what medication you are taking to stabilize, including dosage:For emergency needs, please provide the name and phone number of your health practitioner: Physical Health:Do you have physical health challenges? If so, please tell us what these are. *Please advise if you are on any medications to help with these physical health challenges and your current required dosage:Release and Cancellation PolicyPlease take the time to review and accept our Release and Cancellation Policy below. RELEASE POLICY I hereby release and hold harmless Suzanne Kingsbury and Gateless Writing Inc., from all liability for personal injury, including death, as well as property damage arising out of my participation in the Gateless Writing Retreat in Madison, CT from October 18-21, 2025. I am aware that illness, injury, accidents and other harm are a possibility which may result in incurring costs, expenses, and damages for which I am solely responsible for including, but not limited to, return by air ambulance, or other extraordinary means. I give my consent for immediate care and treatment. I hereby release and agree to indemnify Suzanne Kingsbury for any and all damages, liability or costs resulting from the authorizing medical treatment. I am aware and understand that I should carry my own health insurance. I personally assume all risks whether foreseen or unforeseen. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers, spectators, location staff, coaches, and/or producers of the event. In the event that any damage to equipment or facilities occurs as a result of my willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness. CANCELLATION POLICY: I am aware that I am eligible for a full refund of one hundred percent, six weeks before the retreat or training start date, save the deposit fee. Thirty-five days before the retreat, I can apply monies paid to another retreat or training, save the deposit. 21 days before the training 50% of monies paid can be applied to another Gateless Program. Thereafter, no refund or credit is issued. Gateless Writing does not offer credit for arriving late or leaving early. We are not responsible for your expenses incurred in preparation for any canceled retreat, such as airline tickets, loss of work, and/or other costs associated with preparing for your trip. There is no exception to the Retreat Cancellation Policy including weather or personal emergencies, flight cancellations or delays. We recommend purchasing travel protection insurance through a qualified agent. If we must cancel a retreat, there will be a one hundred percent refund on all funds received to date. Thank you for understanding and respecting the Retreat Cancellation Policy. Do you accept the terms and conditions of the Release and Cancellation Policy above? *I have read and accept the terms and conditions of the Release and Cancellation Policy.Lastly, is there anything else we can help with?Submit