Radiant Life Retreat Application
Event Dates: March 29, 2019 - March 31, 2019
Event Address: Temecula Area (address will be provided upon application acceptance)
Contact us at: jennytam01@gmail.com or ofhealthandwellness@gmail.com
Thank you for your interest! We're so excited that you are ready to get focused and experience life more fully! Please complete the attached form, and feel free to email us with any questions. We look forward to receiving your application! ~ Shannyn & Jenny
Full Name *
Your answer
Email *
Your answer
Address: *
Your answer
Best telephone number to reach you: *
Your answer
Why do you want to attend this retreat? *
Your answer
Are there any topics in particular that you hope to address at this retreat? *
Your answer
There will be an optional light to moderate exercise component to this retreat. If you want to participate, do you have any medical or physical conditions that may limit or preclude you from participating? If yes, please explain. *
Your answer
If you have any medical, psychiatric, or physical conditions as noted above or one that prevents you from fully participating in this retreat, please provide a note from your medical provider that would allow you to participate. You can email it to either address at the top of this application form. *
Your answer
What do you do for exercise and how often? *
Your answer
Dietary restrictions *
On a scale of 1 to 10, where do you consider yourself in your relationship with food? *
I need all the help I can get.
SUPER healthy!
Do you have a meditation or journaling practice in your life? If so, please describe. *
Your answer
If you are selected to participate in this retreat, do you commit to keeping an open mind and open heart? *
If you are waitlisted for this retreat, do you authorize us to contact you in the future for upcoming retreats and events? *
Rules & Legal Stuff....
I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including, but not limited to, suffering and/or death, whether foreseen or unforeseen, that may be sustained by me, or any loss or damage to property owned by me, as a result of my participation in the Radiant Life Retreat ("Retreat"), and all related activities incident thereto. "Related activities" means any and all matters and activities related directly or indirectly to the Retreat, including, but not limited to, travel to/from the Retreat destination, hotel and lodging at the destination, recreational activities, excursions, side trips, and any activity which takes place between my leaving home to the Retreat and my return. In exchange for participating at Radiant Life Retreat I agree to waive, release and indemnify, and hold harmless Orange Fedora Health and Wellness and Soulistic Fitness and its owners and agents ("Released Parties") from any liability, damages and causes of actions arising out of my participation in the Retreat. I understand the risks of my participation in the Retreat, and knowing and appreciating these risks, I voluntarily choose to participate, assuming all risks due to my participation. I warrant to the Released Parties that I have no physical, emotional, or psychological condition which would keep me from participating in and enjoying the benefits of the Retreat or which would cause me injuries or harm, and that I have consulted with my medical doctor/advisor regarding my participation in the Retreat and have obtained his/her clearance to do so. If you agree, please write out: (1) your full name, (2) date of signature and (3) date of birth below. *
Your answer
I grant permission to Orange Fedora Health and Wellness and Soulistic Fitness and its owners to use my likeness in a photograph, video or other digital media (“photo”) taken at the Radiant Life Retreat in its publications including social media platforms and websites, without payment or consideration. I understand that all photos will becomes property of Orange Fedora Health and Wellness and Soulistic Fitness and its owners and will not be returned. I authorizes Orange Fedora Health and Wellness and Soulistic Fitness and its owners to edit, publish, or distribute these photos for any lawful purpose. I also waive the right to inspect or approve the final product wherein the my likeness appears. I agree to waive the right to royalties or other compensation arising or related to the use of the photo. (If you agree, please write out: (1) your full name, (2) date of signature and (3) date of birth below). *
Your answer
I also agree to comply with the property owners' house rules: (Please check each. All must be checked to be accepted). *
Payment Info
Total payment: $799

Deposit: $400
Final payment: $399

I understand that should I be accepted to participate in the Radiant Life Retreat, my spot at the Retreat is not final until the $400 deposit is made (due within 30 days of application acceptance). Final payment for the retreat is due February 28, 2019. Failure to submit either payment on time will forfeit my spot at the Retreat. I understand that should I not be able to attend but have paid, I will have priority for future retreats. All payments made are final and non-refundable. *
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