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NOLA RETREAT

OCTOBER 2025

with Ashley V & Alicia F

APPLICATION 

Samhain Adventure Retreat Application

Thank you for your interest in joining the Samhain Adventure Retreat! This retreat promises a transformative experience filled with adventure, ceremony, and connection. To ensure a harmonious and meaningful journey for all, please complete the application below. Once submitted, we will review your application and follow up with next steps.

Upon acceptance, a deposit will be required to secure your spot. Full payment details, including deadlines and cancellation policies, will be provided in your welcome packet.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.

Tell us about yourself. Share a bit about your background, passions, or interests that drew you to this retreat.

What resonates with you about this retreat?
Have you attended retreats before?
yes
no

If yes, please share a brief description of your experience:

What do you hope to gain from this retreat?
Do you have any dietary restrictions or allergies?*
vegetarian
Vegan
Gluten free
other

Please share all other food preferences and allergies here.

Do you have any medical conditions, mobility limitations, or other considerations we should know about?
This retreat includes significant walking, including on uneven surfaces during city exploration and tours. Are you comfortable with this level of activity?
yes, I am comfortable with extensive walking
no, I may need accommodations

If you answered no, please explain further.

Are you comfortable participating in small, intimate group activities, including ceremonies, adventures, and meals?

Do you have any skills, talents, or interests you’d like to share with the group during our time together?

Are you able to commit to the full duration of the retreat, October 8th- 12th 2025?
Do you agree to respect the group’s shared space and honor confidentiality?*
yes
no

Please share any additional thoughts, questions, or comments you have about the retreat:
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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