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Application for Shamanic Lovers Retreat
February 8-15, 2024
A team member will contact you after your submission
First Name
Last Name
Email Address
Phone
How did you hear about us?
Your Facebook Id Link
What is your age?
Your Gender
Any special dietary needs?
What about physical health concerns or limitations we should know about?
Do you have any mental health diagnosis?
Do you have any history you would consider traumatic? No need to go into details. Just state the situations briefly.
How much altering substances do you consume on a regular basis? This includes alcohol, cannabis, psychedelics, other drugs. This does not include: sugar, coffee, or tobacco.
Your emergency contact name and phone number?
What transformational work have you done in the past?
Who is your partner?
How long have you been together?
What is your Relationship status?
Select...
Married
Not Married
Other
What have been your greatest successes?
What have been your biggest struggles?
What do you hope to get out of this retreat for yourself?
What do you hope to get out of this retreat for your relationship?
Is there anything else you want us to know?
PAYMENT TERMS and REFUND POLICY
I have read the
"Payment Terms and Refund Policy and I agree to these terms.
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COVID CARE AGREEMENT
I have read the
"COVID CARE AGREEMENT" and I agree to this agreement
.
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INFORMED CONSENT AND TRAUMA AWARENESS STATEMENT
I have read the
"INFORMED CONSENT AND TRAUMA AWARENESS STATEMENT" and I agree to these terms.
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