Thank you for registering for

The My Courageous Heart Retreat!

I am SO. FREAKING. EXCITED. that you’ve decided to join us for this special retreat!

You’re all signed up, so what now? This page has some important stuff on it, so scroll down and take a look. 1 and 2 are required!

  1. A general waiver with all the nitty gritty details for you to read and e-sign.

  2. A photo release form to give me permission to take and share your image.

  3. A place for you to share any dietary restrictions you have. The retreat center’s chef will make sure your needs are taken care of!

  4. Roommate requests! If your bestie is coming with you, let me know. Any roommate requests will be honored if at all possible :)

retreat outside.jpg
  1. General Retreat Waiver: Please click here to read through the details and come back to this page to sign.

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E-Signature *
E-Signature
Date of Birth *
Date of Birth
Emergency Contact *
Emergency Contact
Emergency Contact's Phone *
Emergency Contact's Phone

2. Photography Release:

I, for good and valuable consideration, the receipt of which is hereby acknowledged, hereby irrevocably authorize Radical Body Love/Laura Burns to use photographs of me and or my property and authorize her and her assignees, licensees, legal representatives and transferees to use and publish (with or without my name) photographs, pictures, portraits or images in any and all forms and media and in all manners including composite images or distorted representations, and the purposes of publicity, illustration, commercial art, advertising, publishing (including publishing in electronic form on CDs or internet websites), for any product or services, or other lawful uses as may be determined by RBL or LB. I further waive any and all rights to review or approve any uses of the images, any written copy or finished product. I am of full legal age and have read and fully understand the terms of this release.

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E-Signature *
E-Signature
Date *
Date
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3. Dietary Restrictions:

Name *
Name
Please use this space to indicate any dietary restrictions you have. The retreat center's chef will create a menu to fit all of our needs. I may follow up with you personally once I receive the proposed menu from the venue.

4. Roommate Requests: I’ll do my best to honor your request!

Name *
Name