Retreat
Questionnaire

Living Masterpiece by Sammyblu is an intimate, thoughtfully curated retreat experience.
Before reserving your place, you're invited to complete a short questionnaire. It's simply an opportunity for us to get to know one another and begin creating a supportive, connected experience for everyone who joins us. There are no "right" or "wrong" answers! I am excited to learn a little about you.

First name*

Last name*

Email*

Phone*

Birthday*

Year

Month

Day

Instagram Handle

Are you able to attend for the full retreat dates?*

Yes

Accommodation Preference*

Shared Room

Private Room

Have you attended a retreat before?*

Yes

What drew you to Living Masterpiece by Sammyblu?*

What are you hoping to experience, feel, or reconnect with during this retreat?*

At this point in your life, what feels most alive — and what feels most disconnected?*

Do you have any prior experience with the following?*

Barre

Pilates

Dance/Burlesque style

Painting/Visual Arts

None of the above

How do you currently feel about movement and creative expression?*

Very comfortable

Somewhat comfortable

Nervous but curious

Very new to this

This retreat includes embodied movement, creative expression, and group experiences. Are you comfortable participating in a supportive group environment?*

Yes

Somewhat

I have questions

Do you have any injuries, physical limitations, or medical considerations we should be aware of?*

Do you feel able to participate in gentle to moderate movement activities?*

Yes

With modifications

I'd like to discuss

Are you prepared to make the financial investment for this retreat?*

Yes

I'd like to discuss payment options.

How did you hear about Living Masterpiece by Sammyblu?*