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Performance Recovery Retreat

Application, Medical & Lifestyle Questionnaire, and Commitment Agreement

*BEFORE YOU BEGIN

We take this retreat seriously.

Not dramatically. Not with exaggerated promises.But with structure.

This is not a vacation booking form.It is an admission process.

The purpose of this questionnaire is threefold:

To ensure your safety and proper readiness for the physical and metabolic structure of the program.
To protect the integrity of each carefully curated weekly cohort.
To place you in the right mental frame before you arrive.
To customize the experience to your uniqueness.

Most applicants complete this in 7–10 minutes.

Answer honestly. Precision allows us to design your week properly.

Submission does not guarantee admission. Applications are reviewed within 48 hours.

SECTION 1 — IDENTITY

First name*

Last name*

Email*

Mobile*

Date of birth*

Occupation

Address

SECTION 2 — INTENT & TIMELINE

What brings you to consider this retreat at this time?

What would success look like for you at the end of your stay?

How many weeks are you considering?

Preferred starting month

SECTION 3 — HEALTH BASELINE

This section helps us structure your week responsibly.

Height

Current Weight

Goal Weight

Are you currently under medical supervision for any condition?

Yes

If yes, please specify the condition and type of medical supervision

Do you have any of the following?

Cardiovascular condition

Hypertension

Diabetes

Thyroid disorder

Autoimmune condition

Recent surgery (last 6 months)

Are you currently taking prescription medication?

Yes

If yes, please specify the prescription medication/s

Please describe any injuries or mobility limitations

Are you cleared for moderate to high physical activity?

Yes

Not sure

SECTION 4 — STRESS & LIFESTYLE PROFILE

Average hours of sleep per night

Less than 5

5–6

6–7

7–8

Current stress level (1–10)

Exercise frequency

Rarely

1–2 times per week

3–4 times per week

5+ times per week

Alcohol consumption

None

1–3 drinks per week

4–7 drinks per week

8 or more per week

Digital dependency level

Low (less than 2 hours daily outside essential work)

Moderate (2–5 hours daily outside essential work)

High (more than 5 hours daily outside essential work)

How would you describe your current relationship with food?

If you followed weight loss programs or diets in the past, please tell us which ones

Which habits currently impact your energy, weight, or sleep the most?

SECTION 5 — PROGRAM COMMITMENT

This retreat operates on structure.

Please confirm you are willing to commit to:

Early start schedule

Structured meals

No alcohol during the week

Limited phone use

Daily movement sessions

Participation in evening sessions

Which statement best describes your expectation?

I am looking for a relaxing vacation

I am looking for structured, measurable results

Are you willing to be part of a small, carefully curated cohort?

Yes

Do you understand that multi-week participants may remain while new cohorts join each week?

Yes

Please list all of your medical conditions & preferences

SECTION 6 — NUTRITION & ENERGY

Your daily energy pattern is:

Strong and intense

Fluctuating

Steady but low

Low, more mental than physical

When you miss a meal:

You get irritable quickly

You forget to eat

You're fine, no rush

You feel weak or depleted

After eating, you usually feel:

Energized or unchanged

Depends on the day

Heavy or sleepy

Bloated or sensitive

Under stress, you tend to:

React strongly / get impatient

Feel anxious or scattered

Shut down or delay

Overthink or worry

Your body tends to:

Run warm / overheat

Change easily (weight/energy)

Retain weight or feel sluggish

Be lean or tense

Your natural pace is:

Fast and decisive

Variable

Slow but consistent

Careful and analytical

SECTION 7 — INVESTMENT & AVAILABILITY

Which location do you prefer?

Cartagena, Colombia $7,000 USD per 7-night retreat 8-day retreat

Miami, US $11,000 USD per 7-night retreat 8-day retreat

Are you prepared for this level of commitment?

Yes

I need more information

Who is the primary decision-maker for your participation?

Me and my partner

Other

In one sentence: Why should we select you for this cohort?

How did you hear about us?

PARTICIPANT COMMITMENT AGREEMENT

By signing this document, I confirm that:

I have provided truthful and complete information regarding my health, physical condition, and lifestyle.
I understand this retreat does not replace medical, psychological, or psychiatric care, and does not constitute clinical treatment.
I understand I will participate in physical activity, excursions, spa sessions, structured schedules, and nutritional adjustments, and I will disclose any relevant limitations in advance.
I commit to respecting the program schedule, including meals, movement sessions, activities, rituals, and evening sessions.
I agree to abstain from alcohol and any behavior that interferes with the program structure during my stay.
I understand that phone and device use will be limited in alignment with the program design.
I understand this is a carefully curated group environment and I will contribute with respect, punctuality, and a positive attitude.
I understand Hacienda San Benito reserves the right of admission and continuation if a participant compromises safety, group experience, or program integrity.
I understand results depend on my level of commitment, individual condition, and adherence to the structure.
I understand all documentation, payments, preferences, and formalities are completed prior to arrival, as part of the no check-in / no check-out policy.
I acknowledge the inherent risks and voluntarily assume full responsibility for any injury, damage, or loss that may result from my participation. I hereby waive and release the business, its owners, and its staff from any and all liability, past, present, and future, relating to the services provided.
I understand that attendance does not require public image consent, and that incidental background appearance may happen in group settings
I declare that I have read, understood, and accepted the conditions above, and that I participate voluntarily and responsibly.

Media Consent This retreat may include discreet photography, short-form video, and brief testimonial recording for documentation, internal review, and selected promotional use. We treat this respectfully. No participant is required to consent to attend

I consent

I do not consent

Signature*

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