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 Spring Retreat in the gorgeous town of Cortona, Italy, please fill out this form, so we have you on file and can keep track of your beautiful self!!Participant Contact DetailsPlease provide your full contact details and the best way to reach you during the retreat.Name *FirstLastEmail *Phone Number *Participant ProfilePlease provide a short bio and photo that we can feature on our gatelesswriting.com website.Please include a short bio below. *Please upload your photo below (accepted file types: .png, .jpg, .tif, .gif, and .doc; 2 MB max file size). If you are unable to upload your photo, please email it hello@gatelesswriting.com. Click or drag a file to this area to upload. 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 ArrangementsWe would like for everyone to be in Cortona by 1pm on May 5. What time do you plan to arrive?What time do you plan to leave on Monday, May 9th?Health ChallengesDo 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: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. 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 Tuscany, Italy from May 5-9, 2025. I am aware that illness, injury or accidents 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. RETREAT 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, you will be able to apply your retreat monies to another retreat or training, save the deposit. Ten days before the start date of retreat, no refund is issued. We do 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?Thank you for taking the time to complete this form. Can’t wait for our time together! SuzanneSubmit