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Contact

First name

Last name

Phone

Birthday

Year

Month

Day

Multi-line address

Country/Region

Address

City

Zip / Postal code

Emergency Contact

Emergency Contact Name

Emergency Contact Phone Number

Relationship to Emergency Contact

Health + Safety

Do you have any allergies we should be aware of? (Everything and anything including herbs and scents)

Any medical conditions, injuries, or considerations we should know about?

I am a Woman

I am 18+ years of age

Intentions

What is calling you to Witch Camp?

What are you hoping to receive from this experience?

Agreements

I understand participation is voluntary

I agree to respect the privacy of participants

I understand this is a spiritual retreat experience

I accept that photos of me may be taken during this retreat and distributed for social media or content purposes

Liability Waiver

By checking these boxes you agree to the terms of this liability agreement

Witch Camp includes activities such as meditation, sound healing, movement, outdoor activities, fire ceremonies, and food consumption. Participation is voluntary and you may opt out of any activity at any time.

By participating, you acknowledge that you assume responsibility for your physical, emotional, and personal wellbeing.

You agree to release Sabrina Lichtenheldt (Modern Witch Alchemy), Emma Leigh Taylor, and any associated facilitators from liability related to participation, including but not limited to injury, allergic reactions, or unforeseen circumstances, death.

You acknowledge that participation in retreat activities involves inherent risks (as well as unforeseen risks), including but not limited to:

Physical injury

Emotional release or psychological discomfort

Slips, falls, or accidents

Fire related risks

Outdoor and environmental hazards

Allergic reactions to food, herbs, or environmental factors

Discomfort related to movement or physical activity

You voluntarily assume all risks associated with participation in the retreat.

Alcohol and Substance Policy

To maintain a safe, grounded, and intentional retreat environment, Witch Camp is a substance free experience.

Participants agree that no alcohol, illegal drugs, or illicit substances are permitted on the premises or to be consumed at any time during the retreat.

Participants also agree not to attend or participate in retreat activities while under the influence of alcohol or illicit substances.

This policy is in place to ensure:

• Participant safety

• Emotional wellbeing

• Clear consent and boundaries

• A respectful and supportive environment

Failure to comply with this policy may result in removal from the retreat without refund.

By participating, you acknowledge and agree to this policy and understand that facilitators reserve the right to enforce this guideline to maintain a safe and supportive environment for all participants.

By checking this box you agree to comply to all terms.

I agree and understand the Alcohol and Substance Policy

Safety & Conduct Agreement

To maintain a safe and supportive environment, participants agree that they do not have a history of behavior that could pose a risk to the safety, wellbeing, or comfort of others.

This includes, but is not limited to:

• Violent behavior

• Harassment or abusive conduct

• Sexual misconduct

• Behavior that may compromise participant safety

Participants also agree to conduct themselves in a respectful, safe, and supportive manner throughout the retreat.

Facilitators reserve the right to refuse participation or remove any participant whose behavior is deemed unsafe, inappropriate, or disruptive, without refund.

I confirm that I do not have a history of violent, abusive, or unsafe behavior and agree to the safety and conduct guidelines.