NAMELSS Transformation Program Application and Agreement
WELCOME!!! 🙏♾️🙏 WE SEE YOU 🤗 WE CELEBRATE YOU 🙌 

THANK YOU for filling out this application and making this COMMITMENT to YOUR SELF. 

WE APPRECIATE YOU 😇

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Email *
PERSONAL INFORMATION

First Name: *
Last Name: *
Phone Number *
Current profession/job/hustle/SERVICE TO THE WORLD? *
What is your intention in taking this program? What intention will you hold while participating? (Healing, retreat, learning, etc.) Please explain in a few sentences. *
Date of Birth *
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Time of Birth *
Time
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City of Birth *
HEALTH & MEDICAL

Please let us know pertinent info when it comes to your current state of health that you are comfortable sharing.

Any medical conditions, illnesses, or injuries or any medical/health info that you would like us to be aware of: *
Allergies (If onsite, there are resident cats at NAMELSS Ashram): *
Please provide an emergency contact and a means to get a hold of them: *
WHO ARE YOU? WHAT GENIUS DO YOU BRING?

We are here to support the POWER that you are and the GENIUS that you bring to the world. 

To help us best serve YOU, please answer the following questions with openness and spontaneity. Have fun! 

What is Your Genius? What is Your Medicine? What is Your Magic?

If you are currently unsure of any of this and still in a distillation process, it is perfectly okay to be clarifying and refining it. Trust the process.
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What do you see as "The Work"? What do you see as Your Work currently? What Work have you done thus far?
How can we support you bringing Your Genius / Service forward and also "doing the work"?
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WHY NOW? *
What are you looking to EMPOWER and TRANSFORM in your life? *
What do you see HOLDING YOU BACK currently? What are any OLD STORIES/WOUNDS/SHADOWS/HABITS you have been keeping alive that may be sabotaging your integrity and growth? *
What are these things costing you? *
Imagine if you took RADICAL RESPONSIBILITY  right now and made the Full Yes commitment to a life of BECOMING the GREATEST YOU in every way. What does your transformed self look like? What does it feel like? How good can it get? Put it on for a moment and describe it whatever detail come to you. *
How COMMITTED are you to taking the steps towards BECOMING THE GREATEST YOU, and to do the TRANSFORMATION WORK in key arenas of your life (physical, mental, emotional, spiritual etc.)? *
I'm not really sure
Fully committed
Are you willing and committed to INVEST YOUR BEST ENERGY (both time and money) into this alchemy of becoming? *
Why do you feel/think we are the right TRANSFORMATION CONTAINER/SAFE SPACE/CATALYST for you and your growth? *
Have you been in any self development or transformation programs before? *
If  yes, what was it and how did it impact you?
LAST QUESTION

Now that you're at the end of the application, how much more ready do you feel to enter this transformation than when you started? *
Don't feel much of a change
Full Yes!
Permission and Consent:

I, the signee of this application acknowledge while in this service/stay/program, I give my permission to work with Jesse Kunes, Joshua Duke, and NAMELSS LLC as well as permission to deserve, allow, receive, believe and know in anything and everything meant for me in this transformational process. *
Required
Release of Liability:

I, the signee of this application acknowledge am here to inspire my own personal growth and transformation, I alone am responsible for the well-being and perception of my life. I commit to showing up and doing the work. I take full responsibility for my individual experience and outcome associated with this service/program and beyond. Under no circumstances will Jesse Kunes, Joshua Duke, or  NAMELSS LLC, heirs, guardians, legal representatives of/and Jesse Kunes, Joshua Duke, and NAMELSS LLC be held responsible for my actions or circumstances. I hereby and forever irrevocably release, wave, indemnify, discharge Jesse Kunes, Joshua Duke, NAMELSS LLC, and any of their associates affiliates or family of any and all claims. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to myself including, but not limited to, personal injury, disability, illness, damage, death, or expense, of any kind, that I may experience or incur in connection with my participation with Jesse Kunes, Joshua Duke, and NAMELSS LLC.
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Required
Professional Affiliation:

I, the signee of this application understand that Jesse Kunes, Joshua Duke, NAMELSS LLC, and Affiliates are not medical doctors and are not recognized to diagnose, treat, or cure any disease or illness. You should always consult with your medical doctor before making any changes to your diet, prescription medications, lifestyle, or exercise program.
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Required
Nondisclosure and Anonymity:

I, the signee agree to mutual nondisclosure and the preservation of anonymity between I, the signee and Jesse Kunes, Joshua Duke, NAMELSS LLC and or its affiliates for eternity regarding any and all materials, participants, and/or anything and everything related to this stay/service/program.
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Required
Payments and Refunds:

I, the signee understand that all payments are final and nonrefundable. Accepted payment methods include but are not limited to: cash, credit card, or PayPal.
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Required
Entire Agreement:

I, the signee have carefully and thoroughly read and understand this agreement. I am aware that by my typed signature I am agreeing to and legally bound to the aforementioned statements and I accept these terms with gratitude and of my individual Free Will.
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Required
Please Type Your Name to Confirm and Agree to the entirety of this form and agreement. *
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