The Expansion Experience Registration Form

Guest Information

Name

First NameLast Name

Birthdate

Date

Email

example@example.com

Instagram Handle

Home Number

Cell Number

Have you attended a retreat before?

What inspired you to apply for this retreat?

What is your intention for attending this retreat, and what are you hope to gain or experience from participating?

Are you currently pregnant or undergoing any treatments that may require special accomodations?

Are you available to fully participate in all retreat activities, including excursions and ceremonies?

Do you have any health limitations or physical injuries? Please indicate if you have any major health issues (ex high/low blood pressure, arthritis, asthma, diabetes, seizures, osteoporosis, claustrophobia etc.)

Do you have any special dietary requirements? (eg: gluten-free (please specify if you are celiac), allergies, etc…)

Are you planning to pay in full or do you require a payment plan?

We accept Zelle and Venmo or your can pay directly on the website. How would you like to make your payment?

TRAVEL TERMS AND CONDITIONS CHRISTINE MENDES/ SEEK THE EMPRESS LLC and cooperating agencies act only in the capacity of representatives for the participation in all matters relating to transportation and/or all other related travel services and assume no responsibility for injury, loss or damage to person or property in connection with any service, including but not limited to that resulting directly or indirectly from: acts of God, detention, annoyance, delays and expenses arising from quarantine, strikes, thefts, pilferage, failure of any means of conveyance to arrive or depart as scheduled, civil disturbances, government restrictions or regulation, discrepancies or change in transit over which it has no control. This retreat does not include flights and therefore begins when you arrive at destination and ends when you depart destination. Baggage and personal effects are the sole responsibility of the owners at all times. We require travelers purchase trip cancellation/interruption, baggage, medical expense, medical evacuation, accidental death coverage, and emergency assistance insurance. ( Allianz Insurance is an example)

RELEASE AND ASSUMPTION OF RISK : The undersigned has read carefully the conditions of this retreat , as well as the application and participation as outlined in the retreat information, and recognizes and accepts any risks thereof and the conditions set forth therein. The undersigned also understands and hereby agrees to and on behalf of himself/herself, his/her dependents, heirs, executors, administrators, and assigns to abide by the conditions set forth under RESPONSIBILITY, above, as well as in the information provided, and to release and hold harmless Christine Mendes, and all others agents and any of their officers, agent licensees or representatives from any liability for delays, injuries or death, or for the loss of or damage to, his/ her property, however, occurring during any portion of, or in relation to, the retreat referred to in the information provided and in other related documents received by the undersigned, relating to the program and potential risks.

Signature

Date Signed

Date