Cooper Spur Wellness Form Participant Name(Required) First Last Date of birth(Required) Email(Required) Phone Number(Required)Emergency Contact(Required) First Last Emergency Contact Number(Required)Emergency Contact Email(Required) Please indicate your shared lodging preference(Required) All female All male No preference You will have a private bedroom with shared bath.Which session are you attending?(Required) Aug 9-11 Sept 6-8 Sept 27-29 Dietary Restrictions or Requests?(Required) Yes No Please list dietary restrictions or request(Required)Are any health accommodations needed?(Required) Yes No List any accommodations needed for activities. This information is confidential and will be used to provide the best experience. Please list any accommodations needed(Required)Special request for cabin pairing?(Required) Yes No If you are interested in being paired with other participants. 3 guests per cabin. We will do our best to accommodate, but this request is not guaranteed. Name of requested participant(s)(Required)