NAKED: Reclaiming SELF Retreat registration and waiver
I am over-the-moon excited that you are making this giant leap forward on your healing journey. This retreat has been a long-time in the making, inspired by Audre Lorde's Uses of the Erotic, Betty Dodson's Bodysex retreats, and somatic practices. This 2, 1/2 day retreat will be a space to connect to yourself and others, shed your clothes and your insecurities, and bring you back to your SELF. Self = Sexually Embodied Life Force. It's our essence, our sacred wisdom, our passion. It's what makes them tremble and try to snuff us out (I know you know who I mean when I say *them*.) This retreat is for anyone who identifies as a woman and wants to heal from patriarchal, white supremacist, capitalism. 

The Fidget Space is gorgeous and open, yet cozy and intimate. ACCESSIBILITY NOTE: Once you enter the door, there are four flights of stairs to the actual space. I ask that you bring with you a scarf/blanket, something to place down on the yoga mat provided. 

Space is very limited (15 participants) so will be on a first come (meaning registered and paid), first served basis. Please complete the following to register for the April 6th and 7th retreat. Fee can be made payable via Venmo: @passiondoula or paypal.me/passiondoula 

NOTE: If the group healing feels too much for where you are on your healing journey, please reach out for a free consultation to discuss the opportunity for individual support. 
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Payment (Fee can be made payable via Venmo: @passiondoula or paypal.me/passiondoula ) The fee is non-refundable so if you pay and then are unable to attend, you can apply your payment to the next retreat slated for the summer (and each season).  *
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Client Waiver
I release and hold harmless: Elicia Gonzales, the Passion Doula, and all associates from any and all liability for any loss, damage, personal injury, or expense that I may experience as a result of my participation in the NAKED: Reclaiming S.E.L.F. retreat on 4/6-4/7/2024.

I attest that I am of sound body and mind, and take full responsibility for my participation in this retreat and my physical, emotional, and mental health. 

I understand that Elicia Gonzales, all participants, and I will be fully naked throughout the retreat. I also understand that there are portions of the this retreat that contain physically, emotionally, or mentally challenging activities, and take full responsibility for my level of participation in these exercises. 

I understand that I can desist from engaging in any movement or exercise that I may feel uncomfortable with, and if I choose to not do so, I will not hold Elicia Gonzales, the Passion Doula, responsible in any way.

I understand that any sensual/intimate activity that occurs is done with 100% mutual consent and if I am uncomfortable at any time, I can and will clearly express this to all parties involved. If I fail to verbally express my discomfort with any activity. I will not hold Elicia Gonzales, the Passion Doula, responsible in any way. 

I understand that materials provided in this retreat are for personal use only and may not be copied, shared, or reproduced without prior and explicit written consent from Elicia Gonzales, the Passion Doula. 
Electronic Signature. By typing in your full legal name below, you are consenting to the above client waiver.  *
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