Mentorship Circle Weekend

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Welcome To WildHeart! We are thrilled to host you and our old friend Orion for this Mentorship Circle Gathering. This registration is intended to streamline the process of creating a well-supported and logistically easeful weekend this upcoming December 2-4. If you have any questions about this form please contact me directly at Raffles@WildHeartCenter.art

Your Name*

First Last Pronouns

Email*

Enter Email Confirm Email

Access Needs: Is there anything about your body or physical conditions that might impact your stay at WildHeart? If so, what support can we provide?

Fooooood:*

our intention is to provide delicious nourishment for ALL dietary needs/preferences. Please let us know what foods you do and don't eat!

Your Emergency Contact's Name*

First Last

Emergency Contact's Relationship to you*

Emergency Contact's Email*

Emergency Contact's Phone*

Is there anything else you'd like us to know about your stay?

Release from Liability*

I have read and agree to the liability release.

Registered Guests, and all persons accompanying registered occupants, hereby accept responsibility for their personal property and safety and irrevocably release and save and hold harmless WildHeart Collective LLC and WildHeart Center LLC, its affiliates, associates, representatives, and rental property owners from any cost or liability whatsoever arising from loss, damage, personal injury, illness, death, weather-related circumstances, or any circumstance whether caused by the negligence of the Owner or any of the Released Parties or by any other reason, occurring during or affecting a Guest’s reservation or stay.

Digital Signature*

Please input initials or name as your digital signature, for the Liability Waiver above.

$$$: how are you paying?

Cash/Check upon arrival

Venmo: @WildHeartCenter

Credit Card: visit https://tinyurl.com/mentorshipcircleweekend

$240 covers food and housing for the whole weekend. If paying by venmo or credit card, please complete your payment now, along with submitting this form. Thank you!

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