Mountainsong Registration
We are so glad you will be joining us! Please answer the questions below.
Name of the program you are registering for: *
Your answer
What is your full name? *
Your answer
You can state a pronoun preference here if you like (optional):
Your answer
What is your email? *
Your answer
What is your phone number?
Your answer
What is your mailing address (Number, Street, Town, City and Zip Code):
Your answer
What do you most hope to get out of this program? *
Your answer
What medical conditions or mobility issues do you have that we should be aware of? *
Your answer
What medications or herbs are you taking? This information is confidential, and helps us take the best care of you in the unlikely event of an emergency. *
Your answer
Who is your emergency contact? Please give their name, relationship to you, and phone number: *
Your answer
Do you have any allergies to food, medications, animals, or other things? What happens when you are exposed? *
Your answer
Please state all dietary restricitons: *
Your answer
Do you have any questions about this program?
Your answer
Have you submitted payment through the paypal button on our website? In order for your spot to be reserved, we must receive both registration and payment. *
Please remember to hit the SUBMIT button, or all your beautiful answers will be lost!
Thank you... and welcome to the adventure!
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