Embodying the Serpent: A Journey to Sacred Union

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

First Name:
*

Last Name:
*

Pronouns:
*

Best Email:
*

Telephone #:
*

City/State/Country:
*

Emergency Contact:
*

IF YOU PREFER TO MAKE A VIDEO WHERE YOU ANSWER THE APPLICATION QUESTIONS, PUT YOUR VIDEO LINK HERE:

How did you hear about this in-person immersion?

Have you worked with Rebecca or Argon before?

Yes

Other:

Share your experience with anointing, if any (it's not required to come to the retreat):

Share your experience with snake medicine (it's not required to come to the retreat):

What is your experience with sacred sexuality, rites, rituals, ceremony? (It's not required to participate in the retreat)

What draws you to this in-person immersion?

What do you hope to receive from this immersion?

What do you hope to give/offer at this immersion?

Please list any allergies you have:

Certain medications can interfere with or cause adverse reactions with some high-frequency essentials in the anointing oil blends. We provide you with a full list of all of these oils and advise that you check with your health care provider if there are any contraindications. Please share any medications you’re taking and for what purpose.

If you're not taking any medications or supplements, just write N/A.

Please check any of the following as they will help us determine the safety of the oils that are used:

I am pregnant or nursing

History of depression

Sensitivity to scent (what scents?)

NONE OF THE ABOVE

Required

Should you choose to disclose, please list anything (e.g. neurodivergence, health issues, disabilities, impairments) that may impact your experience and accessibility with this program.

Please share anything you want Argon & Rebecca to know:

TRANSPARENCY & AGREEMENTS:

Please read and check all agreements below unless anything poses an issue or raises questions for you. If anything does, please indicate in the space below marked "Other." Rebecca will review your answers & we will also go over these agreements during our Opening/Consent Circle on Zoom, before our immersion.

You’ll receive a copy of these agreements if you’re selected to attend the retreat.

I honor sovereignty and personal responsibility.

I agree to breathe, to feel, to be present and to be authentic.

I agree to maintain confidentiality. This means not disclosing any individual’s identities, stories, and experiences. I acknowledge that I am free to speak about my own experience in the gathering.

I agree to request support, guidance, and help using clear and direct requests when I desire it.

I agree to connect with one of the designated safe, trauma informed people, if necessary.

I agree to take & create the space I need, when I need it.

I agree to take full responsibility for the nature of my experience & not hold Argon Bogar Carrillo and Rebecca Cavender liable.

I agree to maintain a non-violent environment in the gathering, i.e. making sure not to damage myself, anyone, or anything around me.

I agree to be deeply respectful & reverent toward the land where we will gather, as well as the home where we’ll be staying: I will be in relationship with them and also pick up after myself.

If I am taking mood altering prescription medication, I will let Argon & Rebecca know.

This is a drug/alcohol free space: I agree to be sober during our retreat.

Sacred medicine, like blue lotus tea, chaga tea, or cacao, might be offered during the retreat & I will use my sovereignty to discern whether it’s right for me or not.

I agree to not complain about others, and to speak directly to the person I have an issue with. If someone attempts to complain to me about others, I agree to support them to speak directly to the person concerned.

I agree to ask people if they want feedback before I give it to them, and at a time that is suitable for both of us.

I agree to allow people to have their experience and not intervene unless they ask for support: i.e not passing tissues and not giving touch, hugs or advice that has not been requested.

I understand that if I break these agreements, I may be compromising the value I could receive from this experience.

I understand this is a gathering of wild, edge-walking snake medicine keepers here to safely embody the practices, skills, and medicine we hold. This will include explicit terms, sacred eroticism, touch (anointing) and possibly: drumming, rattling, sacred erotic serpentine ritual.

There will be nudity or partial nudity for the anointings—I agree to be in sovereignty over my body at all times.

I am aware this is not a “tame” experience and am willingly participating in the immersion, according to my discernment.

I agree to be in my sovereignty and honor the sovereignty of others, being in consensual experiences every step of the way.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of rebecca cavender. Report Abuse

Forms