LEAD WITH LOVE Event Registration Page

REGISTRATION FOR:

EQUUS ENERGY IMMERSION EXPERIENCE DAY ONE ONLY ($195 PER PERSON) ANIMAL REIKI I CLASS DAY TWO ONLY ($225 PER PERSON) BOTH DAYS = BOTH EVENTS ($400 PER PERSON)

Full Name

NAMES AND AGES OF MINOR CHILDREN ATTENDING (12+ ONLY)

EMAIL

PHONE

YOUR HORSE EXPERIENCE

NONE SOME ALOT

YOUR REIKI/ENERGY EXPERIENCE

NONE SOME ALOT

liability waiver

I UNDERSTAND AND AGREE THAT I AM REQUESTING TO ATTEND AN EVENT ON PRIVATELY HELD PROPERTY with no accessibility features. the terrain may be uneven and i will need to be able to walk, AND/or potentially run/move quickly. I FURTHER UNDERSTAND THAT DOMESTICATED YET UNPREDICTABLE ANIMALS WILL BE PART OF THIS EVENT. I HEREBY AGREE TO INDEMNIFY AND HOLD HARMLESS STACY MITCHELL (EVENT HOLDER), KIMBERLY ROSa (EVENT SPONSOR/PROPERTY OWNER), AND ANY ADDITIONAL SPONSORS/ANIMAL OWNERS AFFILIATED WITH SAID EVENT, FOR ANY ISSUES OR INJURIES SUSTAINED IN CONNECTION WITH MY (OUR) PARTICIPATION. I UNDERSTAND AND AGREE THAT I WILL BE SOLELY RESPONSIBLE FOR MY (AS WELL AS MY MINOR CHILD/REN, IF APPLICABLE) PHYSICAL, MENTAL, AND EMOTIONAL WELL-BEING AT ALL TIMES. I FURTHER ATTEST THAT I UNDERSTAND THAT STACY MITCHELL IS NOT A LICENSED MEDICAL OR MENTAL HEALTH PROFESSIONAL AND NOTHING SHARED DURING THIS EVENT WILL BE CONSTRUED TO BE AN ASSESSMENT, DIAGNOSIS, OR TREATMENT OF ANY ILLNESS OR DISEASE.

PRINT NAME HERE

PAYMENT OPTIONS

CASH OR VENMO DAY OF EVENT LOCAL CHECK DAY OF EVENT PLEASE SEND ME AN EMAIL INVOICE TO PAY BY CARD (PAYMENT REQ 3 DAYS IN ADVANCE OF EVENT DATE)

comments/questions

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