Waitlist Registration Form

Name*

First NameLast Name

Birth Date*

MonthDayYear

Address*

Street Address

CityState / Province

Postal / Zip Code

Email Address*

Cell Phone Number*

I want to be on the HFL Retreats email list. We will not sell your information.*

YesNot yet

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number*

Do you have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Do you have dietary restrictions? If yes, please describe.*

What is your 1st preferred sleeping option? (Please note that rooms will be given on a first come first serve basis and provides a better guest configuration.) Early Access Pricing listed for registrations prior to 1/31/2025*

Bunk shared room $300(reg $340)Solo Room with queen/king bed $400(reg $460)Shared solo room. You have a friend registering. $275/person(reg $305)

What is your 2nd preferred sleeping option? (Please note that rooms will be given on a first come first serve basis and provides a better guest configuration.)*

Bunk shared room $300(reg $340)Solo Room with queen/king bed $400(reg $460)Shared solo room. You have a friend registering as well. $275/person(reg $305)

If you are registering with a shared solo room, what is the name of your friend registering? If shared bunk or solo, type NA. *

What do you hope to gain from the retreat?*

Informed Consent and Acknowledgement

I consent for my participation in any and all activities prepared by Desiree Giles LLC for the women's retreat. In exchange for the acceptance of registration by Desiree Giles LLC, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Desiree Giles LLC and all its respective officers, agents, and representatives from any and all liability for injuries to said self arising out of traveling to, participating in, or returning from selected retreats.

In case of injury to registree, I hereby waive all claims against Desiree Giles LLC . including all affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Medical Release and Authorization

As the registree, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of registree, in the event of a medical emergency, requiring immediate attention to prevent further endangerment of the registree's life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named registree. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact the emergency contact in the most expeditious way possible.

Permission is also granted to Desiree Giles LLC and its affiliates including Directors and Personnel to provide the needed emergency treatment prior to the admission to the medical facility.

Release authorized on the dates and/or duration of the registered retreat.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named registree.

Payment

Upon submission of my registration form and acceptance email received by Desiree Giles LLC to this retreat, I agree to pay a $100 non refundable deposit within 72 hours to secure my spot. The remainder will be due within 7 days from the acceptance email or due upon agreed date between registree and Desiree Giles LLC.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date*

Date

Signature*

Her Fun Life Retreats

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