Wild woman IMMERSION REGISTRATION AND AGREEMENT OF RELEASE & WAIVER OF LIABILITY

BY FILLING OUT THE FORM BELOW, YOU ARE ELECTRONICALLY COMPLETING TO THE AGREEMENT OF RELEASE & WAIVER OF LIABILITY FORM FOR THE WAY OF THE WILD WOMAN: The PRIESTESS - Initiation IN scotland in September 2019

Name *

Name

First Name

Last Name

Email Address *

Which Immersion are you attending? *

Select one of the options below:

The Way of the Wild Woman: Fire Woman

Awakening the Conscious Masculine

Some aspects of this immersion will include nudity. Are you willing to participate in the activities that involve nudity so long as it relates to the healing nature of the immersion? *

Nudity during the Way of the Wild Woman Immersion is used as a form of healing embodiment to help move away from body shame and sexual wounds that may still be present. Nudity is also used as a way to celebrate the feminine and masculine divine present in each of us!

Yes, I am open to the experience

I'm on the fence and will decide later

No, I am not comfortable

Allergies and Dietary Needs

Please indicate and list any allergies, injuries/conditions, dietary restrictions (ex. vegan, gluten free), etc. or NA *

Other Thoughts

Is there anything you’d like to share with us that was not asked? Alternately, is there anything that we can assist you with before the immersion?

Emergency Contact Information

Emergency Contact Name *

Emergency Contact Name

First Name

Last Name

Relationship between you and the Emergency Contact *

Emergency Contact Phone Number *

Emergency Contact Phone Number

Country

(###)

###

####

Emergency Contact Email Address *

Optional Experiences

During the Immersion, we will be offering two optional experiences. These experiences are not included in the cost and are a separate expense to you.

American Disabilities Act

The Americans with Disabilities Act requires companies or organizations that lease space in public facilities for events, conferences, seminars or meetings to ensure those activities are accessible to people with disabilities.

Please describe any special accommodations or access you may need to participate in the Wild Women Immersion.

Do you have metal plates, epilepsy or are pregnant? *

Yes

If you answered "yes" to the above, please provide more information so that we can support you during the Immersion.

Agreement of Release and Waiver of Liability

I acknowledge that I am participating in the Way of the Wild Woman Immersion in Scotland during which I will receive information and instruction about yoga, holistic practices including shamanic and tantric initiations and other healing modalities. I recognize that yoga requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. I also acknowledge that there will be nudity but that I will not be required to partake in any sexual activities with other participants. 2. I represent and warrant that I am physically fit and I have no medical conditions that would prevent my full participation in activities unless discussed prior to the Way of the Wild Woman Immersion with organizer, Veronica Clark. 3. I understand that if I have specific medical conditions, I will list them on my Participant Information form prior to my arrival. 4. In consideration of participation in the Way of the Wild Woman Immersion, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the immersion, including any and all activities done with the group, or as an individual at the Way of the Wild Woman Immersion. 5. In further consideration of participating in Way of the Wild Woman Immersion, I knowingly, voluntarily, and expressly waive any claim I may have against Veronica Clark, Sol Revolution, Inc., and other immersion instructors, for injury or damages that I may sustain as a result of participating in the immersion. I, my heirs and legal representatives forever release, waive, discharge and covenant not to sue Veronica Clark, Sol Revolution, Inc other immersion organizers and/or instructors for any injury. 6. CANCELLATION POLICY: I understand that the registration fee is non-refundable. Should the event be canceled by the organizer Veronica Clark, all fees will be refunded back to me. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree and confirm the above terms. *

Type in First and Last Name to agree

I hereby agree to the following Agreement of Release and Waiver of Liability *

Type in First and Last Name

Date *

Date

This date indicates the date that you agreed to the above Agreement of Release and Waiver of Liability.

YYYY

Photo and Video During the Event

During the Way of the Wild Woman Immersion, the organizers will often take photos and/or videos of the participants engaging in workshops. Your photos could be used in future publications, multimedia presentations, and on the internet. You will also have access to the photos after the immersion. By signing below, you are giving The Way of the Wild Woman, The Wild Tribe, & Veronica Clark permission to use photos for the purposes stated above. *

That's awesome, I'm in!

I'm good, but I do have a couple of concerns

If you checked that you have some concerns with photography, please indicate your concern below.

We love to stay in contact!

Twitter

Facebook, Instagram or other social handles

Thank you, Wild One! See you in Scotland!