Flowing Like Water
Retreat Registration
Name: First *
Name: Last *
Address *
City *
State *	Alabama Alaska Arizona Arkansas California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip code *
Phone number *
Cell Phone
Email *
Emergency Contact (Name, Relationship, Phone, Email) *
Day of Arrival *	Friday Afternoon Saturday Morning
Main Reasons for Attending the Retreat
Roomate Preference(s) - if known
Carpool: Share my contact information with others in a private database so I can carpool	Share Info for Carpool
Special Needs	Light sleeper I Snore loudly Need to be close to bathroom Have trouble climbing stairs (prefer first floor sleeping room)
Special Dietary Needs
Comments/Special Requests
Activities of Interest to Participate in:	Healing: Giving Healing: Receiving Intuitive Sharing Music Performance Sound Healing Performance Excercise Movement Dance

Notes, Waiver and Disclaimer

BY CHECKING BELOW, YOU AGREE TO AND ACCEPT THE FOLLOWING TERMS AND CONDITIONS: In attending and participating in this program, you are doing so at your sole risk and responsibility. Arayu Productions, LC shall not be liable in any way whatsoever (including, but not limited to, negligence) for any special or consequential damages resulting from either your attendance or participation at the event. You agree that Arayu Productions is responsible only for the orderly presentation of the program and that you are responsible for your own participation in the program and your own physical, mental, and emotional well being. CONFIDENTIALITY: You acknowledge and agree that all materials, concepts and information available during the program, including methods, exercises, worksheets, products, designs and wording are proprietary and that their use is restricted. Use of the content or materials for any purpose (other than personal use) without written permission from Arayu Productions is strictly prohibited. It is also understood that strict confidentiality regarding statements made by participants, as well as sharing participants names, is upheld. PHYSICAL AND MENTAL HEALTH RISKS: You hereby release Arayu Productions, LC, its representatives, agents, and employees, from liability for any injury or illness you may incur, now or in the future, as a result of participating in the activities offered to you at the program. The program is not a substitute for medical treatment, psychotherapy, or any health program. You are responsible for your health and well being at all times during the program. INFORMED CONSENT: You represent that you have not registered in the program to handle a physical, mental, or emotional problem and understand that no portion of the program is delivered or supervised by health professionals. You know of no episodes in your past history or that of your immediate family, which suggest to you that you have a mental or emotional disorder or a recurring and unresolved mental or emotional problem. Further, you know of no recurring symptoms, physical or mental, which suggest to you that you may not be able to handle the types of activities described to you as part of the program. You promise to inform the program staff if, at any time during the program, you experience any physical sensation or mental or emotional discomfort which you consider to be out of the ordinary. PHOTOGRAPHS, VIDEO AND AUDIO CONSENT: You agree that any photographs, video clips or audio samples taken or recorded at this retreat by Arayu Productions, LC, are their property and may be used for purposes of disseminating information and promotion of future events.

Waiver * I Agree

Name: First *
Name: Last *
Address *
City *
State *
Zip code *
Phone number *
Cell Phone
Email *
Emergency Contact (Name, Relationship, Phone, Email) *
Day of Arrival *
Main Reasons for Attending the Retreat
Roomate Preference(s) - if known
Carpool: Share my contact information with others in a private database so I can carpool
Special Needs
Special Dietary Needs
Comments/Special Requests
Activities of Interest to Participate in:
Waiver *