Name:
Email:
Phone number:
Arrival date:
Departure date:
How did you find out about the retreat?
I am
vegetarian
vegan
neither
Are you following any specific diet now? Any allergies?
Other medical problems?
Special dietary requests? Choose which type of food you would like to learn more about. We use mostly local and organic food. Please put a number that suggests the importance of learning the recipe or food concept during your stay, with 1 being the least important and 5 being the most important.
Kale chips
Sprouting techniques
Cultured vegetables
Fermented beverages
Sourdough bread and crackers
Gee
Nut butters
Green smoothies
Protein bars
Bone marrow stock
Gluten-free
Other: Do you wish to learn more about
raw foods
cooked foods
cleansing foods
no preference

Which meal is usually your main meal?
Breakfast
Lunch
Dinner

Are you a snacker?
Yes
No

Intentions

Please be as specific as to what your intentions are for the week. We can cover a wide scope while you are here or plan to focus on one area. It all depends on how much time you choose to spend learning the culinary healing arts, having coaching sessions, receiving nutritional counseling, at the beach, on hikes, or simply relaxing. We encourage a minimum of 2 hours a day learning and playing with food.

Please put a number next to each activity that suggests the importance of that activity during your stay, where 1 is the least importance and 5 is the most important.
Culinary classes
Life coaching
Business coaching
Nutritional consulting
Morning breathing and meditations sessions with stretching and light yoga
Daily walk or hike
A swim in the ocean
Farmers market
Garden tour with well-known Kohala herbalist
Organic farm tour
Many more excursions are available at your own expense.