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First Name

Last Name

Phone *

(###)

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date of birth *

MM

DD

YYYY

please select your first choice of accommodation *

Standard Shared Rooms $1450

Bunk Room $1350

King room $1850 (sold out)

Sunset room $950 (sold out)

please select your second choice of accommodation *

Standard Shared Rooms $1450

Bunk Room $1350

King room $1850 (sold out)

Sunset room $950 (sold out)

please select your third choice of accommodation *

Standard Shared Rooms $1450

Bunk Room $1350

King room $1850 (sold out)

Sunset room $950 (sold out)

are you wanting to pay in full or do a payment plan through Moon Clerk? fee is added if doing a payment plan- king room - For payment plan option through Moon Clerk a $170 fee is added for a total of $2,020. Standard Shared Room- For payment plan option through Moon Clerk a $130 fee is added for a total of $1580. Bunk room- For payment plan option through Moon Clerk a $123 fee is added for a total of $1473. Moon Clerk - For payment plan option through Moon Clerk a $89 fee is added for a total of $1039. *

pay in full

HoneyBook payment plan

sleeping habits (check all that apply) *

I am a light sleeper

I am a deep sleeper

I snore or I am not sure but maybe I snore

I go to bed early

I go to bed late

I am a very neat and clean person

I am not a very neat and clean person

I understand that I'm required to complete the 2 zoom sessions before the retreat, I will attend the zoom replays if I am unable to make the live call. these calls will be the bones of our foundation & its important that your caught up before starting the in person experience *

I agree

Use of Image Photographic Release: I grant [Brianna Nicole Sanchez (Jade Sanchez) & Earthbased Media the right to take photographs and video recordings of me during dance classes and events, and to use these images for promotional purposes in print, online, and other media. I understand that by selecting "I Approve" on this form, I agree with this statement. *

I agree

I agree not to use any images provided by Jade Sanchez and Earthbased Media as promotional material for my own projects, businesses, or events. These images and videos are provided to share as art only. I also agree to tag @eathbased.media & @jadeeyemoon when sharing. *

I agree

Refund and Credit Policy The cancellation and refund policy for this retreat is in place to guarantee the fair allocation of slots in the program to students who have been accepted and are ready to commit. Your registration payment to Brianna (Jade) Sanchez is not refundable, returnable, or transferable to a future workshop or to another person. No exceptions. Even in the case of medical or family emergencies, natural disasters etc. Because there is an application and selection process, students cannot ‘sell their spot’ in the program to another person. Please register with full awareness of the agreement you are entering into. Payment , as well as this ‘Mandatory Waiver Form’ must be completed upon acceptance in the given time period to guarantee enrollment in the Intensive sessions. Health/Safety: Student agrees to inform Brianna (Jade) Sanchez of any health conditions or important medications they are taking. Student assumes full responsibility for her/his safety and all risks of participating in this training and while enrolled in the program. We hold no responsibility for any such illness or injury that a student sustains while enrolled in the program. Students who cancel will not be eligible for refunds as per our official cancellation policy. By completing your payment, you have agreed to our refund terms and conditions already. *** If by some unforeseen events or happenings (due to illness, weather, natural disaster or political upheaval, etc) & Jade Sanchez cancels the training, we will refund all deposits and payments, minus an administrative fee. We cannot however compensate airfare or travel costs incurred to come to the training. To cover these risks, we recommend you purchase travel insurance (the best way to protect yourself from unforeseen circumstances like weather, natural disaster, lost baggage, medical expenses, etc). *

I agree