EEretreats

First and Last Name *

Email address *

Phone Number *

Mailing Address *

City, state and zip code *

Emergency contact full name and number *

Please list any food allergies. *

Please list any food intolerances or dietary preferences.

Please list any medical conditions or accessibility concerns (We want to make sure you are safe for all the activities we have planned).

Are you sensitive to any smells (from candles, essential oils, etc)?

What made you decide to come to the retreat? *

How did you hear about us? *

Have you been on a retreat before? If so, what was your experience like? *

Have you done group work before? If so, what was your experience like?

Our conversations can flow in a variety of directions, so many topics could come up depending on the group. For example, self-love, sex, intimacy, energy, spirituality, grief, and much more. Are you open to going through the spaces with each of those topics if they come up? *

Yes

No

Maybe

If you can walk away with one thing at the end of the retreat that would make a difference, what would that be? *

Is there anything else you would want us to know?

Please select a payment option. Please note a $500 nonrefundable deposit is required to hold your spot. All payments must be complete by October 1, 2025. *

Payment in full

Two equal payments

Three equal payments

Please select discount option if available *

Bring a friend discount ($100 off each)

Referral discount ($100 off if you refer someone to any of our offerings, and they sign up).

How would you like to pay? *

Zelle

Credit card (added 2.9% fee)

Check (Please make check to Embodied Experiences and mail to The Grove Counseling attn: Ashley Rogers 6301 Gaston Avenue Suite 360 Dallas, TX 75214 Dallas, TX 75214

Please select your lodging preference. *

$2350.00 The Pelican Room (King bed with private bathroom).

$2350.00 The Gator Bedroom (King bed with private bathroom).

$2150.00 The Magnolia Bedroom (Queen bed with private bathroom).

$1500 The White Tail Bunkroom (Queen bunks with private bathroom).

$2550 The Big Easy (King bedroom with balcony and private bathroom).

Embodied Experiences Retreats. This agreement (“agreement”) is made and entered between and among Embodied Experiences Retreats , hereafter referred to as the “host,” and yourself hereafter referred to as the client. Therefore, the host and the client agree as follows: 1. TERMS A. The purpose of this agreement is to set forth the details of the Embodied Experiences Retreats in Broken Bow, OK as outlined below taking place from October 10-13, 2025. B. The retreat will include the following: 1. 3 nights accommodations at an Airbnb in Broken Bow, OK. 2. All meals and snacks, served buffet style. 3. Daily in person movement, yoga, meditation, creative expression, all materials for workshop. Other activities may be included. 4. Any and all additional costs for lodging, transportation, food and other not listed above are the responsibility of the client. This includes airport and local transfers, souvenirs, offsite lodging, etc. Client acknowledges that no other costs beyond those described herein will be included in the cost of the retreat. 2. PAYMENT TERMS. A. The Client will make payment via zelle, credit card, check or other agreed upon method. B. Payments are final, non transferable, and non-refundable. Should client have to cancel or become unable to attend the retreat, the Client may be eligible to utilize a portion of the payment made towards other Embodied Experiences Retreat events at the discretion of the hosts. If Client booked through BookRetreats or Retreat.Guru, the host will honor their cancellation policy. *

3. DISCLAIMERS. By participating in the Retreat, Client acknowledges that the Host or guest speakers are not acting as medical doctors, psychologists, therapists, lawyers, or financial advisors, and coaching and services provided do not replace the care of other professionals. Yoga, Coaching, or other healing modalities is in no way to be construed or substituted as psychological counseling or any other type of therapy or advice. Client acknowledges that a safe environment is created and maintained by the Host and its members. Primary ingredients are mutual respect and a chance to create trust. Another primary ingredient for a safe environment has to do with confidentiality. The Host and group members are bound by honor to keep what is said in the group confidential. Client agrees that all personal information of any participant relayed within the retreat is strictly and completely confidential. Client understands that while the names of participants will be shared with other participants in the training, the Host shall not disclose any of this confidential information to any other person or entity under any circumstances. The Host may provide the Client with information and/or products that the Host believe might benefit the Client, but such information is not to be taken as an endorsement. The Host is not responsible for any adverse effects or consequences that may result, either directly or indirectly, from any information or teachings provided. Client agrees that these are only suggestions, and the Host will not be held liable for the services provided by any third-party to the Client. The Host is not responsible for any adverse effects or consequences that may result, either directly or indirectly, from any information or services provided by a third-party. Any testimonials or examples displayed are only examples of what may be possible for Client. There can be no assurance as to any particular outcome based on the participation in the Retreat. 4. CLIENT RESPONSIBILITY; NO GUARANTEES. Client acknowledges that the Host has not and does not make any representations as to a future outcome of any kind that may be derived as a result of the Retreat. Client accepts and agrees that Client is 100% responsible for results from the Retreat. The Host makes no representations, warranties or guarantees verbally or in writing regarding Client’s performance. Initial Here: *

5. INTELLECTUAL PROPERTY RIGHTS. In respect of the documents specifically created for the Client as part of this Agreement, the Host maintains all of the copyright, other intellectual property rights, of their Materials. Nothing in this Agreement shall transfer ownership of or rights to any intellectual property of the Host to the Client, nor grant any right or license other than those stated in this Agreement. For the purposes of this Clause, “Material” shall mean the materials, in whatever form, used by the Coach to provide the services and the products, systems, programs or processes, produced by the Coach pursuant to this Agreement. 6. RELEASE. The Host/Company may take photographs, videos, audio recordings, or other recordings during the Retreat that Company may use for future commercial or non-commercial purposes. Client agrees and understands that by participating in the Retreat, Client is consenting to being recorded and photographed and to the use of Client’s likeness, writing, and voice in any media in perpetuity by Host for whatever purpose as Host sees fit. The client shall not make any recordings of any portion of the retreat without express consent from retreat members. Initial Here: *

7. NON-DISPARAGEMENT. The Parties agree and accept that the only venue for resolving a dispute shall be in the venue set forth herein below. The Parties agree that they neither will engage in any conduct or communications with a third party, public or private, designed to disparage the other. Neither Client nor any of Client’s associates, employees or affiliates will directly or indirectly, in any capacity or manner, make, express, transmit speak, write, verbalize or otherwise communicate in any way (or cause, further, assist, solicit, encourage, support or participate in any of the foregoing), any remark, comment, message, information, declaration, communication or other statement of any kind, whether verbal, in writing, electronically transferred or otherwise, that might reasonably be construed to be derogatory or critical of, or negative toward, the Coach or any of their programs, affiliates, subsidiaries, employees, agents or representatives. 8. LIABILITY WAIVER. While the Host will take every possible measure to ensure safety of the Client during the Retreat, the Host cannot control every circumstance. The Client is legally responsible for their safety and any belongings and agrees to, and will be held legally liable for the following statements: I, the Client hereby accept all risk to my health and of my injury or death that may result from participating in the retreat and I hereby release the Host, and the Host’s respective companies, officers, employees, interns, sponsors and representatives from any and all liability to me, my personal representatives, estate, heirs, next of kin, and assigns for any and all claims and causes of action for loss of or damage to my property and for any and all illness or injury to my person, including my death, that may result from or occur during my participation in the retreat, whether caused by negligence of the Host, employees, or representatives, or otherwise. I further agree to indemnify and hold harmless the Host and any third-party from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while attending and participating in the retreat. Under no circumstances will the Host or their assigns be held liable for my injury or death or any loss or damage of my personal belongings, any hotel or travel incidentals, including any damages, resulting from my participation in retreat. Should I require emergency medical treatment as a result of accident or illness arising during my attendance and participation in the Retreat, I consent to such treatment. I acknowledge and I agree to be financially responsible for any medical or legal bills that may be incurred as a result of emergency medical treatment. I will notify the Host verbally and in writing if I am at any time injured prior to, during, or after the retreat in my travels or attendance, or if I have medical conditions about which emergency medical personnel should be informed; however, I understand that the Host are not legally obligated to act on that information in any way or to providing any medical service whatsoever to me. Client agrees to the limits of confidentiality as follows: If you are a threat to yourself or others (showing suicidal or homicidal intent), the host may need to report your statements and/or behaviors to your emergency contacts or other appropriate mental health or law enforcement professionals in order to keep you and others safe. Physical or sexual abuse of a child will be reported to Child Protective Services. When the victim of child abuse is over age 18, reporting is not mandatory unless there are minors still living with the abuser, who may be in danger. Elder abuse is also required to be reported to the appropriate authorities. Initial Here: *

9. MEDICAL & HEALTH CONDITIONS. Client must make the Host aware at the time of booking any pre existing medical conditions, food allergies, or if Client is taking any specific medication, if Client does not make the Host aware of these at the time of booking, the Company will not be held responsible for any health issues that arise from possible contraindications. 10. INTERNET ACCESS & SECURITY. Wireless Internet is not guaranteed and is provided subject to third party terms and conditions, which are available when accessing the system. Consider this the perfect time to disconnect from the noise of the outside world and connect with yourself and your surroundings. Initial Here: *

11. CONSENT & RELEASE PERMISSIONS. By attending the Retreat, you, the Client, are entering an area where photography, audio, and video recording may occur. By attending you consent to photograph, video recording and audio recording and its/their release, publication, exhibition, or reproduction to be used for promotional purposes, advertising, and inclusion on websites. 12. LIABILITIES. The Host shall not be liable for any failures beyond its control. This covers natural disasters, war, other ‘acts of nature’, closure of airports, civil strife, accidents or failure to perform by third parties, including suppliers and subcontractors. The Host accepts no liability for loss, damage, injury or illnesses which may be received during the Client’s stay or travel. 1. DISCLAIMER OF WARRANTIES. The retreat and activities involved provided by the Host under this Agreement are provided on an “as-is” basis, without any warranties or representations express, implied or statutory; including, without limitation, warranties of quality, performance, non-infringement, merchantability or fitness for a particular purpose. I acknowledge that my adding my email above, I will be included in communication regarding this retreat, future retreat offerings and content from Embodied Experiences, LLC. Initial Here: *

13. FORCE MAJEURE. In the event that any cause beyond the reasonable control of either Party, including without limitation acts of nature, war, curtailment or interruption of transportation facilities, threats or acts of terrorism, country travel advisories, labor strike or civil disturbance, make it inadvisable, illegal, or impossible, either because of unreasonable increased costs or risk of injury, for either Party to perform its obligations under this Agreement, the affected Party’s performance shall be extended without liability for the period of delay or inability to perform due to such occurrence. 14. OTHER. Host may have to make changes to details both before and after the retreat has been confirmed and/or cancel the confirmed retreat. The Host will endeavor to avoid changes and cancellations but reserves the right to do so. If the Host must cancel, Client will be informed as soon as possible, and Host will reschedule for an agreed upon future date. Initial Here: *

15. DISPUTE RESOLUTION. If a dispute is not resolved first by good-faith negotiation between the parties to this Agreement, any controversy or dispute to this Agreement will be submitted to the American Arbitration Association. The arbitration shall occur within ninety (90) days from the date of the initial arbitration demand and shall take place in the reception via telephone. The Parties shall cooperate in exchanging and expediting discovery as part of the arbitration process and shall cooperate with each other to ensure that the arbitration process is completed within the ninety (90) day period. The written decision of the arbitrators (which will provide for the payment of costs, including attorneys’ fees) will be absolutely binding and conclusive and not subject to judicial review, and may be entered and enforced in any court of proper jurisdiction, either as a judgment of law or decree in equity, as circumstances may indicate. 16. ENTIRE AGREEMENT. This Agreement contains the entire agreement between the parties and supersedes all prior agreements between the parties, whether written or oral. No representations, inducements, promises, or agreements which are not embodied herein shall be of any force or effect. This Agreement may not be modified, amended, varied, waived, explained, added to, extended, changed in any way, except by a written instrument executed by a person authorized to execute such an instrument on behalf of both the Client and the Host. The parties have caused this Agreement to be signed by their duly authorized representatives as of the Effective Date. I agree to all the terms and conditions of this contract. Initial Here: *

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