Retreat Registration

Registration Form

Please take time to thoughtfully answer these personal questions. All questions  require a response.

Once we have reviewed your registration we will forward a payment request for the non-refundable deposit.

 

The registration form consists of 5 sections and may take approximately 20 minutes to complete. Please give yourself enough time for this.

Contact Information
Feedback Questions

How did you hear about this retreat?

Sleep & Dream Questions
Check all dream experiences you have had. *

Family related questions

General questions
How connected do you feel to your body? (1 is not at all, and 10 is completely) *
How connected do you feel to your emotions? (1 is not at all, and 10 is completely) *

Thank You!

After submitting the registration form, you will receive a confirmation email with a copy of your responses and instructions for payment of your non-refundable deposit.

Please note that your space is not confirmed until we receive payment.

Ethics Statement:

  1. All individuals have their own inner knowing of what it best for them.  The responsibility of Birth-Right is to provide a safe space that fosters the reconnection to that knowing.
  2. We ask that participants be mindful of their own emotional safe zone and be aware of personal transference to the best of their ability in order to provide a safe space for everyone.
  3. As a body centered practitioner, I continue my own inner work and ongoing professional development. I recognize that my capacity to be present in the depth and breadth of what others are experiencing directly correlates to my capacity to be present with myself.
  4. Alcohol and drugs including cannabis are not allowed to be ingested or used during this retreat. Participants will refrain from participating in any exercises if under the influence of alcohol or recreational drugs. There are no exceptions.
  5. Everything that is shared is merely a model of perceiving reality, and all models are meant to be improved upon.
  6. The facilitator and participants will respect the privacy of each individual at the retreat and ensure that they adhere to the confidentiality and liability waiver.