Alchemy of The Spirit Goddess Retreat Egypt  | The Sacred Journey Within Application
Thank you for signing up to participate in Alchemy of the Spirit Goddess Retreat and the Filming of
The Sacred Journey Within Documentary Film.

After you have secured your space (CashApp $farrahsharpe) Please fill out this application and I will contact you to scheduling your pre-care appointments. - Farrah
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Are you coming alone or with a companion? If with a companion, please share their names with me here and send them this form. *
Diet: *
Food allergies and restrictions? *
Are you taking any supplements? If so, what kind? Name of supplement and brand. *
Do you have any medical conditions? *
Are you taking anything prescribed to you by a Doctor for health reasons? If so, please list what medications and their uses. *
Do you have any medical or psychological conditions? * Have you ever been hospitalized? Explain:*   *
Why do you want to come on retreat?   *
Do you have any previous experience with goddess retreats or documentary films?   *
Are you in good health to journey 600 miles, walking and visiting temples? If you have concerns, please share your current state of health. *
Are you currently experiencing any chronic pain? If so, what kind and where?  *
Are you currently experiencing anxiety, panic attacks or have any phobias? If yes, please share more. *
Are you currently experiencing overwhelming sadness, grief or depression? If so, please share more. *
How would you rate your current sleeping habits? 1 No Sleep - 5 A Great Nights Rest *
How many times per week do you generally exercise? *
Have you been on shamanic journey or taken any sacred medicines or psychedelics before? Example: Cannabis, Psilocybin or “Magic Mushrooms , Ayahuasca, Changa, Rape', San Pedro: Huachuma, Peyote; Mescaline, MDMA, LSD,  Ketamine, Iboga, or others? If so please list all that you have taken, where, and when. *
Do you have a history with any type of substances or addictions? Explain: *
Have you in the past or are you currently taking any drugs? I.E. Pharmaceuticals,  Cocaine, Crack, Heroin, or anything else? If so, please list what and when. *
Do you meditate? Yes *
Do you practice yoga?   *
If yes, what style of yoga? *
Do you have a self-care practice or do you need to learn? If so, what does your practice look like? *
What do you do when you feel stressed?   *
Do you experience symptoms of PTSD?   *
Do you experience symptoms of Post Traumatic Slave Syndrome?  *
How do you handle crises? Explain: *   *
Were you treated by a psychologist, psychiatrist, or mental health professional in the past. If so, what happened? When and where?   *
What has caused you the most pain in your life? *
What's your happiest memory? *
What 3 things do you love most about life right now?   *
What are you grateful for? *
What's your favorite song? *
What do you consider to be some of your strengths? *
What do you consider to be some of your weaknesses? *
What is your biggest block in life? *
What do you fear? *
What's your worst habit? *
What is your Astrological Sun Sign? *
Do you practice religion? If so, which one? *
Are you currently employed?  If yes, what do you do? Do you enjoy your work? *
What's your favorite fruit? *
What do you think about the Earth and the current state of our world? *
If you could change three things about your life, what would you change?   *
Would you like to participate in the Documentary Film The Sacred Journey Within and be filmed on retreat? *
Are you able to commit to a an After-Care Session to reconnect after our retreat? This session may be on podcast, sykpe, zoom or a recorded call. You will be responsible for setting up both appointments with me.  *
Are you a therapist, body worker, or healer? Or have you worked with one in the past?  Explain: *
How did you hear about me? * *
Did you send me passport? farrahsharpe@gmail.com *
You will need a Visa for Egypt. Do you agree to get your visa? I will have information soon.  *
Do you have health insurance?   *
Name of your current medical provider and add their phone number.  *
Please add an emergency contact.  *
Consent for Treatment I have read, initialed, and understand the above policies and procedures and informed consent information of Farrah Sharpe, MS, RYT. I understand that I may terminate treatment at any time and that if I have any complaint or grievance regarding my treatment, I will be provided assistance. I agree to the stated terms of treatment and hereby give my consent for treatment. I also acknowledge that I will receive a copy of this agreement.  By Typing your name this is equivalent to a signature and will be used as your lawful and binding electronic signature. *
The Content shared in our sessions is not intended to be a substitute for professional medical advice, diagnosis, or treatment. I am a Mind-Body Medicine  Specialist, and I work with your Doctor. Please share our sessions with your primary care physician, Therapist, or Psychiatrist. If you are having an emergency please call 911 immediately. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on my website or we have discussed in the session. If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 immediately. I do not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on FarrahSharpe.com.  Please select yes if you understand. *
Video Release Form1. I grant the Producer (Farrah Sharpe and her video team, and its designees the right to use my photos and video footage taken at the Sacred Journey Within Production any format, now known or later developed. I grant, without limitation, the right to edit, mix or duplicate and use or re-use in whole or in parts as Producer may elect. Producer or its designees have complete ownership of the Product, including copyright interests. 2. I grant Producer and its designees the right to broadcast, exhibit, market and otherwise distribute the Product, in whole or in parts, and alone or with other products, for any purpose Producer or its designees determine. This grant includes the right to use the media for documentary film, youtube, Facebook, Instagram, twitter, linked and other mediums, online and print formats for promoting or publicizing. 3. I have the right to enter into Agreement and am not restricted by commitments to third parties.4. The producer has no financial commitment or obligations to me as a result of the Agreement. 5. In consideration of all the above, I hereby acknowledge receipt of reasonable and fair consideration from Producer. I have read, understand and agree to all of the above and that the rights granted Producer herein are perpetual and worldwide I agree to the terms above. Please type your name below. This serves as a digital signature. *
We will be wearing All Chakra Colors including White. Do you agree to come dressed in chakra colors on retreat? *
Which future Journeys are you interested in? *
Please answer yes or no to the following statement: I hereby give Farrah Sharpe & The Sacred Journey Within permission to use my photographic likeness in images or videos taken during this retreat on their website, in print material, social media, or other broadcast media for the use in promotion of their projects and programs.
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Any other questions or comments?
Thank you. Namaste.
Welcome to Alchmey of the Spirit on The Sacred Journey Within - Pack up! Its Almost time to go!!! Namaste.
 - Farrah
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