Provider Group Registration | HeartwoodExpeditions

Provider Groups and Retreats Registration Form

Participant First Name

Participant Last Name

Pronouns and Preferred Name

Phone

How did you hear about this group?

What are you hoping to get from this experience?

Do you have any concerns about participating in this group?

Do you have any allergies or dietery restrictions?

Do you have any medical conditions we shoud be aware of?

Is there anything we can do to make your experience with us more enjoyable?

I have carefully read and fully understand the contents of the Heartwood Expeditions Waiver. I am aware that this is a release of liability and a contract, and I sign it of my own free will. By signing below, I voluntarily agree to all the terms and conditions, including the assumption of all risks associated with any Heartwood activities.

Your Signature

Event fee is $75, and all proceeds will go towards building infrastructure for ecotherapy and community access at Fern Hill. Your contribution is appreciated!

After clicking the registration button you will be routed to the donation page for Fern Hill where you can make your payment.

If you cannot make a donation at this time and are interested in work-trade please email Mat at matapeseche@gmail.com

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