Registration Form Spring Retreat - The Nourished Woman

Name:*

First

Last

E-mail:*

Phone*

Area Code

Phone Number

Address:*

Street Address City State / Province / Region Postal / Zip Code Country

Emergency Contact Name:*

First

Last

Emergency Contact Phone:*

Area Code

Phone Number

Relationship to Emergency Contact*

Spouse/Partner

Family Member

Friend

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Meal Preference: All food will be prepared and served in the Main Lodge by the Camp Trillium Rainbow Lake Kitchen Staff. These meals will include; Friday: dinner Saturday: breakfast, lunch and dinner Sunday: breakfast and lunch Coffee and Tea are readily available throughout the day.*

Anything Goes!

Vegetarian

Vegan

Paleo

Gluten Free Vegetarian

Gluten Free Anything Goes

Gluten Free Vegan

Bunk Companion Request: (please include first and last names and separate individuals with a comma). We will do our best to accommodate requests but can not guarantee such requests. Requests will be given on a first come first serve basis.

Sleeping Preferences: If possible we will try to put like sleepers together.

Retire early

Night Owl

Retire early -Watch out I snore!

Night Owl - Watch out I snore!

Accommodation Style you will be choosing. Please note if you are coming alone or as a pair and choose the 3-4/room we will match you up with other bunk mates. If you are coming alone and select double occupancy we will select another single double occupancy registrant to pair you with.*

3-4/room

Double Occupancy

Although you do not need to reserve or register for workshops in advance, the exception to this is Creating Sacred Altars so that we can have enough materials. This workshop is limited to 10 participants.

Please save me a spot in the Creating Sacred Altars Workshop. Should I change my mind I will let you know ASAP.

Are you a smoker?*

yes

I understand that Camp Trillium Rainbow Lake is a nut free zone and I agree that I will not bring any nuts on to the Camp Trillium property.*

I agree

I acknowledge and agree that my personal belongings are my responsibility. There are no secure places for them to be stored, with the exception of the vehicle I arrived in. I will not hold The Nourished Woman team or Camp Trillium Rainbow Lake responsible for my belongings.*

I agree

I have read and agree to the Cancellation & Refund Policy.*

I agree

Should I choose to pamper myself with a treatment/service in the Healing Oasis, I understand that it is my responsibility to inform the practitioner of any personal information, health or otherwise, that may be affected by the treatment. I release Camp Trillium, The Nourished Woman, it's team members and volunteers from all liability related to my treatment/service.*

I agree

Liability Agreement: 1. I certify that the above information is true and complete, to the best of my knowledge. I fully understand that I am solely responsible for my health, safety and well-being while participating in all retreat activities. I agree that I will inform my instructors of any activity which I cannot perform safely, and that I will not perform any activity which I feel is likely to cause me to injure myself. I understand that there are risks associated with any physical exercise. While every precaution shall be taken to ensure the good welfare and protection of the participant, The Nourished Woman Team and Camp Trillium, its Directors, staff members, employees, volunteers, or facilities outside of the camp grounds are hereby released from any liability in the event of any accident or misfortune that may occur to the applicant. Each participant must be covered by Provincial Health Insurance or equivalent medical insurance. 2. In the event that a participant requires special medical, x-ray or treatment beyond that which is available at Camp Trillium, the signature on this registration shall give the The Nourished Woman or Camp staff and/or the nurse/medic the right to arrange for any special services and/or medical attention necessary for the participant’s welfare and good health. In such a situation, the Nourished Woman will attempt to notify the emergency contact as soon as possible. The participant is responsible for any additional expense that may result from such services including but not limited to the cost of emergency transportation to a medical centre or hospital if required. 3. I grant permission to The Nourished Woman and persons acting for or through The Nourished Woman the right to use, reproduce, and/or distribute photographs, films, video tapes and sound recordings of myself for use in materials they may create for purposes of promoting The Nourished Woman. **

I have read and agree to the Liability Agreement

I understand that although I may choose to go swimming, who knows what Mother Nature has in store for us, there is no life guard on duty at any time and I swim at my own risk. *

I agree

Have you been to a Nourished Woman Retreat before?*

yes

How/Where did you hear about this Retreat Weekend?*

Method of Payment;*

Credit Card/Paypal

Cheque

Cash

E-Transfer

Word Verification

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