$EX & SOUND 2022 🌺
~ Intake and Liability Release Form ~
* Indicates required question
Phone Number (for confirmation text): *
Your answer
Name: *
Your answer
Date of Birth: *
MM
/
DD
/
YYYY
What drew you to this offering? *
Your answer
Do you have any experience with Sacred Sexual Healing Work?  Please explain briefly. (Note: none required) *
Your answer
Are you able to stay for the full day from 10am - 10pm? If not, please explain *
Your answer
I understand that $EX & SOUND 2022 explores sexuality and that nudity will be part of the event (nudity is NOT required, however it will be an option during some exercises). *
Required
I release, covenant not to sue, discharge, and hold harmless Anna Ruth Hall and Raven Royce from any and all claims, actions, damages, liability, costs, expenses, and attorney’s fees which are related to, arise out of, or are in any way connected to my participation in the the Sex & Sound Event or use of the Temple Space. By this agreement, it is my intention to surrender and waive any rights to sue or exercise any legal right to seek damages from Anna Ruth Hall, Raven Royce, or any other entity, organization, or individual in conjunction with this event, including all facilitators, land stewards, and members of the team. *
Required
I hereby certify that I am over 18 years of age, I have carefully read the foregoing of this document, and acknowledge that I understand and agree to all of the above terms and conditions. *
Required
Virtual Signature (Type Name Below): *
Your answer
Today's Date: *
MM
/
DD
/
YYYY
How will you be sending your payment?

Early Bird Before Sept 11th: $222
Regular: $333
Regular + Coaching: $555

Venmo (@embodyinganna), Paypal (paypal.me/earthsongbirthing), or Zelle (earthsongbirthing@gmail.com).

 *
Your answer

What to Bring: ~2 SARONGS OR 1 SHEET & 1 SARONG
(this is super important!!!)
~A YOGA MAT ~Your water bottle ~Any snacks or nourishment you'll need for your specific diet beyond our light, provided meals.

 *
Required
Any questions or notes for us (including special needs or medical conditions)?

We are so excited to connect with you all soon! Once we receive your PAYMENT & THIS FORM we will confirm your participation in the $EX & SOUND Sensorium.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms
Help and feedback
  •  
     
     
    Contact form owner
  •  
     
     
    Help Forms improve
  •  
     
     
    Report
Sign in to continue
Cancel
sign in
To fill out this form, you must be signed in. Your identity will remain anonymous.
Report Abuse
Cancel
sign in