REMEMBER YOURSELF · NOVEMBER 13–15, 2026

Your Comfort.
Your Choice.

Please complete your participation agreement before the retreat. Each guest—including guests already booked and complimentary guests—can use this form. It does not reserve a place or collect a payment.

Photography and video permission is completely optional. You are equally welcome whether you choose Yes or No. No choice is selected for you. Please complete this form for yourself.

Questions or prefer a paper form? Contact Rebekah before signing. Please share health or accommodation concerns privately rather than entering them here.

Your Participation Agreement

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I am at least 18 years old.I have read and understand the participation agreement, including its release of certain legal claims, and voluntarily agree. I agree to sign electronically.

Optional Photography & Video

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What is your preference? Please select one.Yes, I give permission under the optional photography and video consent above.No, I do not give permission. I prefer not to be photographed or recorded for promotional use.

Your Details & Signature

Full nameEmailEmergency contact nameEmergency contact phone

Type your full name as your electronic signatureYour signature records your agreement and the separate photo choice you selected. It does not turn a No into permission.

Your name, email, signature, emergency contact, selected choice, document versions and submission date will be stored privately for Coast & Crow’s retreat administration and consent records. This does not subscribe you to marketing.

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Your Comfort.Your Choice.

Your Participation Agreement

Optional Photography & Video

Your Details & Signature

Thank You

Your Comfort.
Your Choice.