Unbound Retreat Registration
Welcome to your most expansive year yet.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What are you hoping to experience by participating in Unbound?
*
Do you have experience with any of the following? Check all that apply.
*
Guided meditation
Yoga
other movement practices (dance, Qigong, etc.)
Creative visualizations
Breathwork
None
Other
Please add any details you'd like about prior experience with any of the practices listed above.
Dietary Restrictions
*
None
Vegetarian
Vegan
Gluten-Free
Dairy-Free
Nut Allergy
Other
Please describe any dietary restrictions you have.
Movement Limitations or Physical Restrictions
*
None
Difficulty walking or standing for long periods
Balance or coordination issues
Use of mobility aids (cane, walker, wheelchair)
Unable to sit on the floor for long periods of time (back jacks and other support will be available; a chair can be provided as necessary).
Other
Please describe any particular physical restrictions or mobility needs you may have.
How did you hear about this retreat?
Is there anything else you'd like me to know?
Emergency Contact Name
*
Emergency Contact Phone Number
*
Emergency Contact Relationship
*
CANCELLATION POLICY: Cancellations made 14 days or more before the retreat will receive a full refund. Cancellations made within 14 days are non-refundable, but your spot may be transferred to another person with prior notice.
*
I agree
LIABILITY WAIVER: "I understand that meditation, movement, and group activities involve inherent risks, and I am participating voluntarily. I accept full responsibility for my wellbeing and release the facilitators and venue from liability for injuries or harm that may occur during the retreat, except in cases of gross negligence."
*
I agree
Signature
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UNBOUND Retreat
$
275.00
Quantity
1
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Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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