Fall Beach Retreat 2025

Fall Beach Retreat ~ Sandbridge, Virginia

Soul Support Systems, Participant Form
Name*

First NameLast Name
Email*
example@example.com
Date*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Home Phone Number*
Please enter a valid phone number.
Cell Phone Number
Please enter a valid phone number.
Emergency Contact Name*

First NameLast Name
Relation to Emergency Contact*
Emergency Contact Phone Number*
Please enter a valid phone number.
The following information is extremely helpful. We will do our best to accommodate your requests.
I have the following dietary considerations, requests, or recommendations. Please include allergies and/or food preferences. (See list at end of this sheet for specific questions.)*
Requests: Do you have any requests for us or is there anything else you would like to share?*
Do you have a roommate or sleeping preference?*
Please complete the following if applicable:
Airport:
Airline/Flight #:
Arrival Time/Date:
Departure Time/Date:
Comments about travel/roommate/accommodation preference:
I certify that my answers are true and complete to the best of my knowledge.
Signature*

Powered by Jotform SignClear
Today's Date*

Fall Beach Retreat ~ Sandbridge, Virginia

Soul Support Systems, Photo/Video Release & Consent Agreement
Name*

First NameLast Name
I, (above name), hereby grant Soul Support Systems permission in conjunction with the following program: Fall Beach Retreat 2025, to take my photograph/image, audio and/or video record my voice, and photograph, audio and/or video record my work in the retreat.

I hereby grant Soul Support Systems permission to use, edit at their discretion, publish and distribute to the public; any photos, videos, audios, and likeness, and any digital medium or any other form of electronic or print medium of myself from my participation in this program with Flo Magdalena and Soul Support Systems; for any commercial purpose such as advertising, promotional materials, events and any other form of media and marketing for Soul Support Systems. I waive any right to inspect or approve such images and recordings and to royalties or other compensation for the authorized activities. I understand that the images and recordings, in whatever medium, shall remain the property of Soul Support Systems.

I hereby consent and irrevocably release and hold harmless, Flo Magdalena and Soul Support Systems from any reasonable expectation of privacy or confidentiality associated with the images and recordings specified above. I further acknowledge that my participation is voluntary and that I will not receive financial compensation of any type, associated with the taking or publication of these photographs or recordings, participation in company marketing materials or other company publications. I acknowledge and agree that publication of said photos or recordings confers no rights of ownership or royalties whatsoever.
Permission granted.Permission NOT granted.Permission must be obtained per photo, video and likeness, and any digital medium or any other form of electronic or print medium of myself.
I hereby release Flo Magdalena and Soul Support Systems, its facilitators, contractors, employees, and any third parties involved in the creation or publication of marketing materials, from liability for any claims by me or any third party in connection with my participation.

I understand that this is the sole, complete and exclusive agreement between me and Soul Support Systems. I certify that I have read and fully understand and agree to the terms of this Release and Consent Agreement.
Signature

Powered by Jotform SignClear
Today's Date*
Should be Empty:

Fall Beach Retreat ~ Sandbridge, Virginia

Fall Beach Retreat ~ Sandbridge, Virginia