Phoenix Rising Retreat Registration Form
We are so glad you have decided to join us for the Fanning Your Spark into Flame Retreat for 2021.  As you know, this will be our last Retreat and so, after all the work we have done, year after year and after the year we have been through, it has been dubbed: The Phoenix Rising Retreat 2021. It is going to be an extra special affair and we are so pleased that you will be sharing this with us.

Please complete the following registration form and waiver.


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Email *
Name *
Date of Birth *
For the purpose of the booklet that will be created specifically for you to use for the 4-day Workshop.
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Place of Birth *
For the purpose of the booklet that will be created specifically for you to use for the 4-day Workshop.
Address *
Contact Phone Number *
Emergency Contact Person *
Emergency Contact Email *
Allergies or Health Concerns *
Please include any information you feel the Retreat Organizers would need to have access to in the case of an emergency.
Release of Liability *
NATURE OF RISKS: I understand that by attending a retreat/event of this nature may involve certain risks beyond the reasonable control of The Hive and Grove and retreat organizers. Such risks include, but are not limited to, accidents, emergencies, exposure to reckless conduct of other persons, and/or negligence of security and medical personnel. The Hive and Grove and retreat organizers hereby disclaims any and all liability and responsibility for any such risk. I understand that I may choose to be at various sites and that there may be an opportunity to participate in recreational or other activities, and that I will participate at own risk and subject to all terms and conditions set by any supplier, recreational or other provider.                                                                                                                                                         WAIVER OF LIABILITY/HOLD HARMLESS: By signing this liability waiver, I agree and acknowledge that I may be giving up important legal rights and remedies available to myself, my family, my heirs, successors, and assigns. For value received, I agree on behalf of myself, my heirs, successors, and assigns (“Our Behalf”) that I assume all risks and waive any claim of liability of any nature whatsoever against, and agree to indemnify and hold harmless The Hive and Grove and retreat organizers with respect to any and all actions, claims or demands that may be made or brought on Our Behalf against The Hive and Grove and/or retreat organizers arising out of or in connection with travel to or attendance at the retreat or any other activity I may engage in while participating in the retreat/event. Further, for value received, for any injury to third parties that may arise because of my own actions or omissions, I agree to indemnify, hold harmless and defend The Hive and Grove and retreat organizers with respect to any and all actions, claims, expenses or demands arising therefrom that may be made or brought against The Hive and Grove and/or retreat organizers, including but not limited to reasonable attorneys’ fees and expenses arising in connection therewith.                                                                                                                                                        MEDICAL EMERGENCY: In case of medical emergency where I may become incapacitated, I understand that a reasonable effort will be made to contact my emergency contacts. In the event that they cannot be reached, I hereby give permission to the physician selected by The Hive and Grove and/or retreat organizers to hospitalize, secure proper treatment for, and to order injection, anaesthesia or surgery for myself.
Required
Assumption of Risk *
 I acknowledge and understand that participation includes possible exposure to and illness from infectious diseases including but not limited to COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness does exist; 2. I knowingly and freely assume all such risks related to illness and infectious diseases, such as COVID-19 and 3. I hereby acknowledge that I must comply with all set procedures (i.e. social distancing, masks where deemed necessary) to reduce the spread while on the Phoenix Rising Retreat, including advising retreat organizers immediately if I start to experience Covid symptoms, including but not limited to: fever, dry cough, difficulty breathing
Required
Un Poco Loco from the movie Coco
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