Registration for Tantra Massage for Couples

Your Full Name

Full Name of Your Partner

Your Email

Email of Your Partner

Your Phone Number

Year of Birth

Which program are you registering for?

Select from dropdown

Will you be paying via e-transfer (Bryarly@EarthNectar.ca) or credit card (note there is a 3% surcharge)?

Vocations of You and Your Partner

What do you and your partner hope to gain/experience/learn by attending this retreat?

What experience do you and your partner have in Tantra and/or other modalities that support your loving connection?

What are the current main stressors in your life?

Have you or your partner experienced any form of sexual, physical, or emotional abuse?

Yes

Rather not say

If yes to the previous question, and if willing, please briefly explain. This information is kept strictly confidential and is only asked so I can better support you; it is not required.

Do you have any impairments, illnesses, diseases, recent surgeries or injuries (less than a year ago):

We will be doing physically active practices such as dynamic breathing and movement. Participants with health concerns should consult their doctor before registering.

NOTHING
mental illness
recent surgery (less than 1 year ago)
cardiovascular disease
skin infection transmitted by contact
communicable disease, including STIs
spinal injuries, fractures of the pelvic bones and lower extremities, traumatic brain injuries
other (specify below)

If you answered Other to the question above, please specify any other disorders or bodily issues that the retreat facilitator should be aware of.

Does your partner have any impairments, illnesses, diseases, recent surgeries or injuries (less than a year ago):

We will be doing physically active practices such as dynamic breathing and movement. Participants with health concerns should consult their doctor before registering.

NOTHING
mental illness
recent surgery (less than 1 year ago)
cardiovascular disease
skin infection transmitted by contact
communicable disease, including STIs
spinal injuries, fractures of the pelvic bones and lower extremities, traumatic brain injuries
other (specify below)

If you answered Other to the question above, please specify any other disorders or bodily issues of your partner that the retreat facilitator should be aware of.

Are you or your partner presently taking any medications? If so, please name them.

Is there anything else you or your partner would like to share about yourselves? (For example, it could be preferred personal pronouns, special needs, or anything else you want the facilitator to be aware of.)

Name and Phone Number of Emergency Contact

How did you hear about the retreat?

Do you agree to receive electronic communications from Bryarly McEachern at Earth Nectar?

You can unsubscribe at any time, either by sending Bryarly@EarthNectar.ca a direct email with subject Unsubscribe, or by clicking the Unsubscribe link at the bottom of any newsletter.

Yes I agree to receive electronic communications from Bryarly McEachern at Earth Nectar.

Please read, understand and agree to our Terms and Conditions and Privacy Policy in its entirety before submitting your registration form for the Event. The sections include: Informed Voluntary Consent; Confidentiality; Photo, Video and Audio Recording Is Prohibited; Privacy Policy; Payment Policy; and Cancellation Policy

Click Terms and Conditions and Privacy Policy to view. I certify that I have fully read, understand and I agree with all points in the Terms and Conditions and Privacy Policy.

LEAVING THE EVENT

I agree not to leave a practice or leave the Event without first talking to the retreat organizers or teacher.

PHOTO AND VIDEO CONSENT

When you arrive at the retreat, I will give you and your partner a brief consent form to fill, indicating whether you do or do not want photos/videos to be taken of you during the retreat. Photos and videos are only taken with a participant's consent, without nudity and never during intimate practices, and participants have the option of checking photos taken of them before they are used for promotion. Participants may request a copy of any photos/videos taken solely of them. Photos/videos, where permitted, are taken very sparingly, if at all.

I already know that I do NOT want photos or videos taken of me.

I already know that I DO want photos or videos taken of me.

I am not sure yet and will wait until the day of the retreat to decide.

OTHER PROGRAM DETAILS

Program payment: Payment is due upon submitting your registration form. Please send your payment of $300 CAD immediately via e-transfer to Bryarly@EarthNectar.ca or by credit card (3% surcharge) via the Pay By Card link that appears after submitting this form. Your registration is complete only after you have sent your payment. We will send you a confirmation email within 1 business day.

Retreat Schedule: Saturday July 6, 9:30 am - 6:30 pm

9:10-9:25 am Arrival and Sign-In

9:30 am Opening and Morning Session

12:00-1:00 pm Lunch & Free Time

1:00 pm Afternoon Session & Short Break

6:15-6:30 pm Closing Circle

Please make sure you are committed to attending the whole retreat before registering and submitting your payment. Participants arriving late may be denied or delayed entry due to the sensitive and immersive nature of this retreat.

Orientation Information for Participants: A map of the retreat location, orientation information, and suggestions for what to bring, will be emailed to participants 2 weeks before the retreat, by June 22.

Cancellation Policy: Cancellation requests received at least 30 days before the start of the program will receive a full refund, minus a non-refundable deposit of $50.
Cancellation requests received less than 30 days before the start of the program will not be eligible for a refund.
Exceptional circumstances may be considered by the organizer, in which case you may be eligible for a program credit (minus the $50 non-refundable deposit) for use in other programs offered by the organizer within 1 year of the original program date.

CONFIRM AGREEMENT WITH OTHER PROGRAM DETAILS

I have read, understand, and agree with the Other Program Details mentioned above.