2025 HFC Registration Form

2025 Hypnotherapy Fantasy Camp Registration Form

Name

Phone Number

Emergency Contact Name

Emergency Contact Phone Number

Birthdate

Preferred Pronoun

She/Her

He/His

They/Them

Shared Accommodation - Preferred Roommate's Name

How did you hear about Hypnotherapy Fantasy Retreat?

Have you ever used the services of Hypnotherapy?

If so, by whom?

Have you ever been diagnosed with any type of of seizure disorder?

Have you ever been diagnosed with schizophrenia?

Are you sensitive to scents (essential oils, incense, perfumes etc.)? If yes, please let us know the details:

Do you have any health limitations or physical injuries? Please indicate if you have any major health issues (ie: high/low blood pressure, arthritis, asthma, diabetes, seizures, osteoporosis, etc.):

Please list any current physical restrictions given to you by a health care provider:

What inspired you to come to this retreat?

Do you have any dietary restrictions?

Do you have any special dietary requirements? (ie: gluten-free (please specify if you are celiac), allergies, vegan, etc.):

Is there anything else you would like us to know?

Accident Waiver and Release of Liability Form In consideration of the risk of injury while participating in HYPNOTHERAPY FANTASY RETREAT (the “Activity”), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims, or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge SACRAMENTO HYPNOTHERAPY WELLNESS CENTER located at 4250 H ST, SUITE 4, SACRAMENTO, CA 95819, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct results of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity. I am voluntarily participating in the aforementioned Activity entirely at my own risk. I am aware of the risks associated with traveling to and from as well as participating in this Activity, which may include, but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others’ negligence, conditions related to travel, or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from, and during this Activity. I certify that I am physically fit, and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity. I agree to indemnify and hold harmless SACRAMENTO HYPNOTHERAPY WELLNESS CENTER against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If SACRAMENTO HYPNOTHERAPY WELLNESS CENTER invite any of these types of expenses, I agree to reimburse SACRAMENTO HYPNOTHERAPY WELLNESS CENTER. I acknowledge that SACRAMENTO HYPNOTHERAPY WELLNESS CENTER and their directors, officers, volunteers, representatives, and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on my behalf. I acknowledge that I have carefully read this “waiver and release” and fully understand that it is a release of liability. I expressly agree to release and discharge SACRAMENTO HYPNOTHERAPY WELLNESS CENTER and all of its affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against SACRAMENTO HYPNOTHERAPY WELLNESS CENTER for personal injury or property damage. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of SACRAMENTO HYPNOTHERAPY WELLNESS CENTER, its agents, and employees. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event that any damage to equipment or facilities occurs as a result of my or my family’s willful actions, neglect, or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions or neglect or recklessness. I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. As I participate in activities offered by the hosts and special guests, I understand that the offerings of this retreat are not a substitute for medical attention, examination, diagnosis, or treatment. If at any time during the activities I feel discomfort or pain, I will inform and seek assistance from the host of the retreat. I may rest at any time during the retreat and over the weekend. I will listen to my body and respect its limits on any given day. I recognize that it is my responsibility to notify the host of this retreat of any serious illness or injury before every class. I accept that neither the retreat hosts, nor the hosting facility, are liable for any injury, or damages, to person or property, resulting from my participation in this retreat. I understand that the $500 deposit for the retreat is final with no refunds and the balance of my payment is due by July 21, 2024. Cancellation fees will apply due to associated costs such as the catering service, accomodations, special guests, swag etc. I agree that all cancellations made less than three weeks in advance of the retreat be paid in full and that I may transfer my spot to another person. Exclusion of Participation: In the unfortunate circumstance, if a guest conceals physical and/or health issues, is unfit, and/or causes disruptions that endanger the provision of the service and/or the health of other participants,facilitators, or equipment the guest can be excluded from the participation of the Retreat after an initial warning. If the situation arises, the contract will be terminated without further notice, already paid costs are non-refundable and incurring costs are to be paid by the guest. In the event of illness of the participant prior to the event. Monies paid can be transferred to hypnotherapy services at Sacramento Hypnotherapy or for a future retreat. I certify that I have read this document and I fully understand its content. I am aware that this is a release of liability and a contract, and I sign out of my own free will.

Sacramento Hypnotherapy Wellness Center Sacramento Hypnotherapy Wellness Center-A Private Ministerial Association By joining Sacramento Hypnotherapy Wellness Center, a Private Membership Association and/ or any website or Social Media Group started by, created by, maintained, or organized by the Association, Agreement as follows. 1. This Association of members declares that our objective is to allow the Private Membership Association founders and all Private Membership Associations members with a platform in which to conduct all manner of private business with the Association and with other Associations and Association members, keeping all business in a private domain and utilizing the protections guaranteed by the Universal Declaration of Human Rights (UDHR), the Constitution to conduct business in private and to provide a platform for members to conduct business in the private domain under all protections acknowledged and guaranteed by the Constitution of the UNITED STATES, and any previous protections guaranteed. 2. We believe that the Universal Truth, the Universal Declaration of Human Rights (UDHR), the Constitution of the United States of America, the various constitutions of the several states of the union, and the Charter of Rights of Canada guarantees our members the rights of absolute freedom of religion, free speech, petition, assembly, and the right to gather together for the lawful purpose of helping one another in asserting our rights protected by those Constitutions, Charter and Statutes, in addition to the rights to be free from unreasonable search and seizure, the right to not incriminate ourselves, and the right to freely exercise all other unalienable rights as granted through the Divine , and guaranteed by those Constitutions, Charter, and Statutes. WE HEREBY Declare that we are exercising our right of “freedom of association” as guaranteed by the Universal Declaration of Human Rights (UDHR), the U.S.Constitution and equivalent provisions of the various State Constitutions, as well as the Charter of Rights of Canada. This means that our Association activities are restricted to the private domain only and outside of the jurisdiction of government entities, agencies, o ffi cers, agents, contractors, and other representatives as provided by law. 3. We declare the basic right of all of our members to decide for themselves with Association members could be expected to give wise counsel and advice concerning all matters including, but not limited to education, physical, spiritual, and mental health care assistance, law, and any other matter and to accept from those members any and all counsel, advice, tips, who we feel are able to properly advise and assist us. 1 4. We expect the freedom to choose and perform for ourselves the types of therapies and treatments that we think best for diagnosing, treating, and preventing illness and disease and for achieving and maintaining optimum wellness, as well as the freedom to choose for ourselves any types of assistance which may be made regarding law and any other private business activity. 5. The mission of this Association is to provide members with a forum to conduct business between members in the privation domain with the protections guaranteed within the aforesaid Constitution and Charter remaining fully intact. 6. The Associate will recognize any person(s), natural or otherwise (irrespective of race, color, or religion)who have joined this Association or any social media group organized, created, or managed by this Association and is in agreement with these principles and policies as a member of this Association, providing said person has not been sanctioned, exercise, or otherwise banned by the association, and will provide a medium through which its individual members may associate for actuating and brining to fruition the purposes heretofore declared. 7. Membership to this Association, “Sacramento Hypnotherapy Wellness Center”, and any of its groups may be terminated by the association Trustees or their designee, at any time, should they conclude that a speci fi c member is interacting with them or any other members in a way that is contrary or detrimental to the focus, principles, and betterment of the Association. 8. I understand that, since the Association is protected by the First, Fourth, Fifth, Ninth and Tenth Amendments to the U.S. Constitution, it is outside the jurisdiction and authority of Federal and State Agencies and Authorities concerning any and all complaints or grievances against The Association members or other sta ff persons. All rights or complaints or grievances will be settled by any Association designee, committee, or tribunal and will be waived by the member for the bene fi t of The Association and its members. By agreeing to this membership form I agree that I have sought su ffi cient education to determine that this tis the course of action I want to take for myself. 9. I agree to join Sacramento Hypnotherapy Wellness Center, a private membership association under common law, whose members seek to help each other achieve better health and good quality of life. (A) I am voluntarily changing my capacity from that of a public person to that of a private member. My activities within the Association are a private contractual matter that I refuse to share with the Local, State, or Federal Investigative or enforcement agencies. I fully agree not to pursue any cause of legal action against a fellow member of The Association, unless a member has exposed me to a clear and present danger of substantive evil, and upon the recommendation and approval of the Association. 10..I enter into this agreement of my own free will without any pressure or coercion. I a ffi rm that I do not represent any Local, State or Federal agency whose purpose is to regulate and approve products or services, or to carry out any mission of enforcement, entrapment or investigation. I have read and understood this document, and my questions have been answered fully to my satisfaction. I understand that I can withdraw from this agreement and terminate my membership in this association at any time, and that my membership can and will be revoked if I engage in abusive, violent, menacing, destructive or harassing behavior towards any other member of The Association. These pages consist of the entire agreement for my membership in The Association. I agree this contract began on the date of my joining “Sacramento Hypnotherapy Wellness Center”. I declare that by joining this Association and/or the Associations websites and/or social media group(s), I have carefully read the whole of this document and understand and agree with it.

2025 Hypnotherapy Fantasy Camp Registration Form

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