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

Suggested donations are $75 to help Serena develop a public-access family nature area. Payment can be made to Serena directly via Venmo at @serena-torrey, or you can bring cash/check to the retreat. If you cannot make a donation at this time and are interested in work-trade please email Mat at matapeseche@gmail.com

Thanks for submitting!

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