Application for "Discover Your Genius" Retreat Program

Directions for Completing the Application Form:

Welcome to the application for our Discover Your Genius Retreat! Please carefully read the following instructions to ensure you select the correct option for your application.

1. Self Pay Option:
If you have the financial means to pay for the retreat and are ready to commit to attending, please select the Self Pay option. This option is for those who are able to pay for the full cost of the retreat. We will review your application to confirm your eligibility and availability for the retreat.

2. Sponsorship Option:
If you are interested in attending the retreat but require financial assistance to do so, please select the Sponsorship option. This option is for individuals who need help financing their participation. We will review your application to confirm your eligibility and availability for the retreat.

Important Notes:

After submitting your application, we will review your information and notify you whether your application has been accepted.
If accepted, you will receive an email with instructions and next steps for confirming your participation, including a calendar link to select an available retreat date that works best for you.

Self Pay

Apply for Sponsorship

Personal Information

Your Full Name (First Name, Last Name)

Your Age

Your Phone Number (Best contact number)

Your Email Address

Your Address (Street, City, State, ZIP Code)

City

State

ZIP Code

Why This Retreat?

What is motivating you to apply for this retreat? (Challenges and passions)

What are the key personal goals or changes you hope to achieve by attending this retreat?

What are some of the passions or interests you have, and how would you like to reconnect with or develop them further?

Eligibility & Readiness

We appreciate your openness and honesty in providing this information. Our goal is to create a supportive, judgment-free space for all attendees.

How committed are you to engaging in deep self-reflection and personal work during this retreat?

Are you able to commit to the full 5-day retreat experience?
YesNo

Do you have any health or medical conditions we should be aware of?

Do you currently use any of the following substances?
(Please check all that apply and provide details as needed.)
Alcohol

Tobacco/Nicotine

Cannabis/Marijuana

Prescription medications (e.g., for anxiety, depression, pain, etc.)

Non-prescription or recreational drugs (e.g., cocaine, psychedelics, etc.)

Other

If you are using any of the substances listed above, please provide additional details:
Type of substance:

Frequency of use:

Any impact or challenges related to this use in your life:

If applicable, are you currently in treatment or recovery for substance use?
YesNoNot Applicable

Do you anticipate being able to refrain from using substances during the retreat?
YesNoUnsure

If you are actively using substances that might interfere with your participation or safety during the retreat, we may recommend that you consider postponing your attendance until you are able to fully engage in the program.

Additional Information

Additional Comments or Questions:

Agreement & Consent

I consent to the collection and use of my personal information for the purpose of reviewing my application and providing program support.

Signature*

Only participants over the age of 18 or legal guardians/parents of participants can legally sign this contract.

Date:

After you submit the application you will be notified by one of our team members regarding application approval, payment link and further details. Thank you.

Sponsorship Section

Has someone already sponsored you?
YesNo

Who sponsored you? (Please provide the name of the individual or company)

Personal Information

Your Full Name (First Name, Last Name)

Your Age

Your Phone Number (Best contact number)

Your Email Address

Your Address (Street, City, State, ZIP Code)

City

State

ZIP Code

Why This Retreat?

What is motivating you to apply for this retreat? (Challenges and passions)

What are the key personal goals or changes you hope to achieve by attending this retreat?

What are some of the passions or interests you have, and how would you like to reconnect with or develop them further?

Eligibility & Readiness

We appreciate your openness and honesty in providing this information. Our goal is to create a supportive, judgment-free space for all attendees.

How committed are you to engaging in deep self-reflection and personal work during this retreat?

Are you able to commit to the full 5-day retreat experience (if selected for sponsorship)?
YesNo

Do you have any health or medical conditions we should be aware of?

Do you currently use any of the following substances?
(Please check all that apply and provide details as needed.)
Alcohol

Tobacco/Nicotine

Cannabis/Marijuana

Prescription medications (e.g., for anxiety, depression, pain, etc.)

Non-prescription or recreational drugs (e.g., cocaine, psychedelics, etc.)

Other

If you are using any of the substances listed above, please provide additional details:
Type of substance:

Frequency of use:

Any impact or challenges related to this use in your life:

If applicable, are you currently in treatment or recovery for substance use?
YesNoNot Applicable

Do you anticipate being able to refrain from using substances during the retreat?
YesNoUnsure

Additional Information

Additional Comments or Questions:

Agreement & Consent

By submitting this application, I understand that the selection process for sponsorship will be based on individual need and program alignment. Participation is subject to availability, and if I am selected, I agree to be available for one of the retreat dates and program conditions. I consent to the collection and use of my personal information for the purpose of reviewing my application and providing program support.

Signature*

Only participants over the age of 18 or legal guardians/parents of participants can legally sign this contract.

Date:

After you submit the application you will be notified by one of our team members regarding application approval and further details. Thank you.