Create & Release Form

Create & Release Registration

I’m glad you’re here. Please fill out the form below to reserve your place in this small, guided group. Space is limited to keep it intimate and supportive.
Full Name

First NameLast Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Number of people attending
If registering more than one person, please list the name(s) of additional attendee(s).
Participation Acknowledgment

By checking the box below, you acknowledge that this event is not therapy, counseling, or crisis support.

By registering, participants acknowledge personal responsibility for their emotional and physical wellbeing during the gathering and understand that attendance is voluntary.

This gathering is intended for adults ages 18+ only.
Registration & Payment

Gathering contribution: $15 per person

To reserve your spot, please submit the registration form.

Payment instructions will be sent in a follow-up email.
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Create & Release Registration