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Retreat Intake/Registration
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Email
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Your email
What is the name you wish to be called?
*
Your answer
Email & phone number
*
Your answer
Where are you coming in from?
*
Your answer
Will you be driving or needing a ride?
*
Driving I have room to pick up one more
Driving yet I'm unable to take others
I would love a ride
Other
Do you have any heath concerns or Injuries we should know about?
*
Your answer
Do you have any dietary restrictions other than Vegetarian?
Your answer
How much personal growth or self development work have you done? (It's ok if the answer is zero)
Your answer
Who is an emergency contact person? Name/Relationship/phone number
Your answer
Agreement by the registrant to the use and distribution of the registrant's image or voice in photographs and videos of such events and activities hosted by Shara Ogin.
I'm ok with occasional photos/videos if taken upon discretion.
I'd rather not be filmed at all
Other
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Liability Release: By signing below, I release Shara Ogin and assistants from all liability which may arise from any and or all claims by me or any third party in connection with my participation in the retreat. Please type your name below.
Your answer
Anything else you would like to share?
Your answer
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