Participant Information Form

Skip to content

Name*
First Last
Email*
Phone*
Is this a cell phone?*
- Yes
- No
Birthday*
Passport #*
Medical Information
Please enter none where appropriate:
Allergies*
Special Dietary Needs:*
Please share any food preferences or sensitivities, i.e. vegetarian, vegan, lactose intolerant, gluten free, etc.
Medications*
Any medical conditions (Is there anything that would prevent you from walking 3-6 miles/ day on this retreat?)*
Smoker/ Non Smoker (Hotel Pitti Palace is a non-smoking hotel)*
- Smoker
- Non Smoker
Emergency Contact Information
Name*
First Last
Relationship to participant*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
About You
We are excited that you will be joining us in Florence. Help us tailor the trip to you, please tell us a bit about yourself.
What creative passions or interests do you pursue or want to pursue?
How do you currently capture inspiration?
What is one thing that you wish to gain from this trip?
Is there a project on which you are working that you are facing any blocks, challenges, or trouble completing? Please describe the project, where you are at with it and what is your challenge.
What is something that you have always wanted to do or try but haven’t yet?
Is there anything special that you want to do in Florence?
What’s your dominant learning style?*
- Auditory
- Visual
- Tactile
If you are unsure, here is a link that describes them and a quiz you can take to determine your learning style.
What type of music do you like to listen to when you are being creative? What are some of your favorite artists or songs? (Will will be exploring the role of music and creativity.)
Is there anything you want us to know about you?
Have you traveled internationally previously?*
- Yes
- No
How did you hear about this retreat? Who can we thank for sharing this opportunity with you?
Travel Insurance:*
- Yes, I purchased or plan to purchase travel insurance and will email my insurance details.
- No, I decline to purchase travel insurance and I assume any financial loss associated with my travel plans.
We strongly recommend you purchase travel insurance. Artfully Inspired Retreats, LLC does not provide travel insurance.

Δ

Participant Information Form

Medical Information

Emergency Contact Information

About You