Request edit access
Retreats Participant Form ~ Om Side of Things, LLC
For people of all ages.

The ancient art of storytelling unites us. Each of us is an inspirational story because each of us is alive on the planet. We are empowered when sitting-in-story together. Forming a circle to awaken. Connecting with each other, nature, muses, spirit guides, and intuition. Journaling. Reading. Creating. Compassionately listening to each other’s stories, life experiences, and wonderings. Clarifying. Healing. Thriving.

Whether meeting with you privately or in a group, it’s an honor to hold space for you to empower the inspirational story of who you are .... the illumination of your innate light!

What do you wish to empower and manifest in your life?

I'm Jessica Amber Barnum (Jess). I'm a teacher and author. I teach intuitive guidance, yoga, storytelling & writing, and book design & self-publishing. My offerings are inspired by the scribe tribe vibe, love, and life experiences!

When we empower ourselves, we empower the planet! This is the Om Side of Things.

Specific details for each retreat will be posted on my website's Retreats page.

If you are a parent completing this form for your minor child (ages 10 -17), please complete this form together. Thank you!

Love, 
Jess :)
970.456.7241
Sign in to Google to save your progress. Learn more
Participant's Name *
Participant's Age *
(For minor participants only) Parent's Name
(For minor participants only)  Parent's Cell #
(For minor participants only)  Parent's Email 
What is the name of the specific Retreat you are participating in, and what is the age group and fee listed? (see details on my website's Retreats page) *
What is your preferred method of payment?  Payments are requested upon completing this form. Thank you! *
Required

This Retreats Participant Agreement is being made between myself, Jessica Amber Barnum, on behalf of Om Side of Things, LLC, and you, the participant, and/or your minor child. 

For people of all ages. 

Payments are requested upon completing this form. Options are: 
 -Cash 
 -Venmo @omsideofthings

There is a no refund policy for Retreats offered by Om Side Of Things, LLC. In the event that you (or your minor child) is unable to attend due to illness or other circumstances, you can apply the fee as a credit toward a future Class or Retreat. If I (Jess) must cancel for reasons such as illness or other circumstances, refunds will be granted. 

Please be on time.

Consent & Release For Retreats For All Participants. I have read, understand, agree to and accept this statement from Om Side of Things, LLC: The information I share verbally or in written form is for educational and informational purposes only and is solely to be considered and used at your discretion for you (or your minor child). I am not providing medical, psychological, spiritual, philosophical, or nutrition advice as a diagnosis or clinical recommendation.  Insights I may share in Retreats are for you (or your minor child) to discern if they resonate with you (or your minor child) or not, and for you (or your minor child) to determine what action steps based on those insights you (or your minor child) independently decides to implement in life or not. You (or your minor child) should not use this information to diagnose or treat any health problems or illnesses without consulting your family's own medical practitioner. Always seek the advice of your own medical practitioner and/or mental health provider about any specific health situations. 

I voluntarily consent to my (or my minor child's) participation in Retreats organized by Om Side of Things, LLC. I waive and release Om Side of Things, LLC from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which I (or my minor child) have ever had, now have or may claim to have in the future against Om Side of Things, LLC arising from my (or my minor child's) past or future participation in, or otherwise with respect to, anything related to and including the Retreats. In no event will Om Side of Things, LLC be liable to me, (or my minor child), or to any person for any direct, indirect, special, incidental or consequential damages for any use of, non-use, or reliance on the Retreats, its information, programs and/or services, including, without limitation, personal injuries, accidents, misapplication of information, or any other loss, malady, disease, difficulty, injury, or otherwise, to me (or my minor child) even if I am advised of the possibility of such damages, difficulties, or injuries, whether caused by the fault of myself (or my minor child), Om Side of Things, LLC, other attendees, or other third parties. I agree to pay for all damages to the facilities caused by any negligent, reckless, or willful action that I (or my minor child) may take. 

FOR PARENTS OF MINOR CHILDREN. I understand that as a parent or legal guardian, Om Side of Things, LLC may wish to voluntarily disclose to me general details about my minor child's progress, or may be required by law to disclose certain information to me, pertaining to my minor child's health, safety and wellness. I understand that I am encouraged and urged to discuss any questions or concerns that I have about issues of confidentiality with Jessica Amber Barnum and my minor child.

*
Required
What other details would you like me to know?  What questions do you have? 

Thank you for completing this form. I look forward to seeing you! :) 
*
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report