Retreat Induction Form

Please answer all the following questions as best possible. They will help me understand what your expectations are about the retreat, and also clarify what you intend to get out of it. Your entries on this form are strictly confidential.

Please could you complete the form at least 48 hours prior to the retreat. Thank you!

Name*
First Last
Email*
Start Date of Retreat*
DD slash MM slash YYYY
1. If you could only use one word to describe yourself, what would it be?*
Just one word please!
2. Without being humble, what do you value the most about yourself?*
This could relate to your work, personal life, family, skills etc
3. What one change over the next 3 months would make the greatest difference to you?*
Please try to be as specific as possible
4. What would you like more of in your life?*
5. How will you know that this retreat has been successful for you?*
6. What are the challenges you're facing right now?*
Please describe briefly your short/ medium/ or long terms challenges
7. What are you grateful for?*
8. What would you most like to let go of in your life?*
Please be as specific as possible
9. How satisfied are you with your life right now?*
Pick a number from 1 to 10, with 1 being completely unsatisfied
to 10 being completely satisfied.
10. What question would you most like to ask me?*
11. What are the top 3 things you'd like to get out of this retreat?*
Please be as detailed, and specific as possible - thinking about this upfront allows for a stronger, more productive interaction during the retreat.
12. Other notes or comments
Please note down any questions, or points you'd like to talk about in our retreat
(or any general comments). Please also indicate if you would prefer to ask these questions privately.

Retreat Induction Form

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