Clone of Rooted MaMas Retreat Form

Witchy Retreat Form

Join us for a retreat full of manifesting and witchy fun!
Full name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Post CodeCountry
E-mail
example@example.com
Phone Number
Emergency contact

First NameLast Name
Emergency contact phone number
Please enter a valid phone number.Format: (000) 000-0000.
Preferred sleeping arrangement ( not guaranteed)
Friends name thats coming with you. So we can make sure to put you together.
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.
Do you have any dietary requirements/allergies?
Important

By signing I understand that Rooted Women is not responsible or liable for any choices I make. I understand that this is non-refundable, but can be transferred to another guest. I also agree if doing a payment plan to pay the full amount by January 31, 2027.
Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
My Products
prevnext( X )
Rooted Women Retreat deposit
$111.00 Quantity



Rooted Women Retreat paid in full. Price increase 11/15

$888.00 Quantity



Full Retreat price after 11/15
$999.00 Quantity



Total

$0.00
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty:

Witchy Retreat Form