Full Name
Email
Phone Number
Emergency Contact (please include name, phone number, and relationship)
Room Preference Solo Sanctuary (Single, sleeps one): $3,195
Shared Horizon (Double, sleeps two): $2,895
Triple Hearth (sleeps three): $2,395
Collective Grove - Dorm: $1,995
Dietary Needs: Please list any allergies or specific dietary requirements (Vegan, GF, etc.) for our organic kitchen.
Roommate Request: If you are coming with a friend or loved one, please provide their name here.
What is calling you to Ireland at this time in your life? Have you been to Ireland before or this your first trip?
Describe your current relationship with technology and your nervous system. (Are you feeling burnt out, in transition, or seeking a deeper "rest-and-digest" state?)
The Offline Experience: When was the last time that you spent 72 hours with no technology (if ever)? Do you have any fears, concerns, anxieties, desires, longings, or hopes when imagining going offline in Ireland?
History: Do you have any history of significant trauma or medical/psychological conditions that may require specific support during a deep immersion? (This information is held in strict clinical confidence).
Wild Wonder: What is a question you are sitting with right now, in your relationship to creativity, nature, and/or technology?
What is one thing you are hoping to leave behind in West Clare, and one thing you are hoping to carry home with you?
Final Payment Acknowledgement: I understand that full tuition is due by April 22, 2027.
Deposit Acknowledgement: I understand that a $850 non-refundable deposit is due now to complete my retreat booking (the deposit is transferrable to another person or We Human offering).
Payment plan: Would you like to arrange a monthly payment plan for the remainder your retreat tuition? Yes
No
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