Journey to Self-Love & Abundance - Mt. Shasta Retreat
Event Timing: Sept 30th - Oct 3rd, 2022
Event Address: Mt. Shasta, CA
Contact Song: (916) 741-0749 or songbirdjourneys@gmail.com
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Full Name *
Email *
Phone *
Gender Identity *
Are you sharing a bunk/bed with a friend? 

If Yes, please type the name of your friend. If No, type "No,"
 *
Dietary restrictions *
List Any Food Allergies
Do you understand sleeping quarters and bathroom accommodations are shared? *
What is your preferred accomodation? *
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I understand that I will have to pay $555 deposit upon approval of this application and the remainder is due before the start of the retreat. *
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What is your preferred method of payment for the deposit?
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I understand that transportation/drive/flight to and from Shasta are my responsibility. I will do my best to keep facilitators informed of my flight arrival and/or drive time arrival so that everyone is accounted for any picked up appropriately. I understand activities begin 9/30 at 4 pm, and I am advised to arrive the beforehand in order to make this time. *
Emergency Contact: Full Name & Relationship  *
Emergency Contact: Phone Number
Do you have a spiritual practice? I.e. Prayer, meditation, yoga, or other rituals?
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Please list your Spiritual Practices here:
What are you most looking forward to by attending this retreat?
Confidentiality Notice: You will only speak about your experience, in the first person, and not share names or personal experiences with anyone who was not on our journey. *
If you have any injuries or limitations, please let your facilitators know prior to commencing any activities and please list them below:
Are you on ANY prescription medications? If so, please list which and amount taken, how many times per day & how long you have been on it (in case of emergency arises, we can be informed).
Are you experiencing any emotional disorders like anxiety or depression? If so, please list. 
On an average day, how severe are your emotional disorders? 
None
Very Severe
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Cancellation/refund policy: The initial deposit can be fully refunded up until Sept 1st. After Sept 1st, if you cannot make the retreat all funds received will be credited toward the online version of the course or a future retreat.
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