Clone of Ascended Masters Spring Equinox Retreat form

Information Fill Out - Polishing Your Pearl Retreat Experience

7/31 - 8/2
Full name

First NameLast Name
Birth Date

DayMonthYear
Address

Street Address

Street Address Line 2

CityState

Post CodeCountry
E-mail
Phone Number
Emergency contact

First NameLast Name
Emergency contact phone number
Health Details

In order for us to best serve each participant on the retreat, please answer the following questions. All answers will be kept strictly confidential.

Rows	Yes	No
Do you have or have you ever had any physical health problems, eg. diabetes, epilepsy, high blood pressure?*
Do you have or have you ever had any mental health problems, eg: anviety, depression, PTSD?*
Are you now taking any prescribed medication?*
Are you now taking any of the following drugs: barbiturates, amphetamines, cocaine, heroin, hallucinogens?*
Do you have muscle or joint problem that could worsen by a change in your physical activity?*

If you answered "Yes" to any of the questions above, give details of all occurrences. Include the following: dates, frequency, type, amount etc below
Do you have any dietary requirements/allergies?
Are you currently moving through an addiction? If yes, state below
What would you like to receive or what is your intention for coming to the event?
Will you have a RV or large camping vehicle? If yes, state below
Experiencing how many days?
Could you use a payment plan?
Did you get directly referred by someone? If so, state who below for their referral bonus!
Thankh you for being open to joining the retreat! You will be emailed or receive a text message from Marcus (Christolight) after your submission to talk further details such as pricings & package options.

If you have any questions that you wish to discuss prior to participating in the retreat, please do so before committing yourself to the program.

I realise that retreats held by Sacred Light Retreats require my mental and physical health and I certify that I am fit to undertake it.

I agree to honor the boundaries set in the event space & land.
Initials
Thank you

Wholeness Balanced Love
Should be Empty: