Moonspell & Serenity

A Witchy-Glam October Retreat for Identity, Nervous System Reset, and Big “I’m Back” Energy

Event Application

October 26 Retreat Application

Please complete this form to be considered for a spot.

Your answers help us place you in the right room and support you safely and comfortably.

Applicant Information

First Name *

Last Name

Preferred name, if different:

Pronouns (optional)

Phone *

Email *

City & State

Date of birth

Instagram Handle

Emergency Contact

Emergency Contact Email

Name *

Emergency Contact Phone *

Relationship

Retreat Fit and Intentions

A few questions to help us make sure the retreat is the right container for you.

What called you to this retreat? (1–3 sentences) *

What do you most want to feel on the other side of this experience? *

Have you attended a retreat, group healing intensive, or similar experience before? *

Yes

No

If yes, what kind?

Interests and Preferences

(So we can tailor your experience)

Which experiences are you most excited about? (Check all that apply) *

Witchy photoshoot

Equine therapy

Animal communication session

Goat yoga

Group Spinal Energetics

Cacao ceremony

Fire ceremony

Sound bath / healing

Smashing pumpkins (release ritual)

New moon ceremony

Guided meditation

Chakradance session

Breathwork

If you had to pick your TOP 3 priorities, list them here:

1)
2)
3)

What vibe do you want more of? (Check all that apply) *

Rest + nervous system downshift

Transformation + breakthroughs

Spiritual connection

Play + joy

Nature + grounding

Community + sisterhood/friendship

Quiet + solo integration time

Anything you do NOT want? (Triggers, hard no’s, strong preferences) *

Rooming and Lodging

Room type preference (select one): *

Private room (single occupancy)

Shared room (double occupancy)

Open to either based on availability

Bed preference (if applicable): *

Queen/Full

Twin

No preference

Roommate request (optional). If you’re coming with someone, list their name:

Any sleep-related considerations? (snoring, light sleeper, CPAP, etc.)

Payment Selection

How would you like to pay? *

Pay in full

Deposit + payment plan

Other (please explain below)

If other, please share

Preferred payment method (check all that apply): *

Credit/Debit card

Bank transfer

Venmo

Zelle

PayPal

Other

If payment plan: what cadence works best for you?

Weekly

Bi-Weekly

Monthly

Notes or questions about payment:

Food, Allergies, and Dietary Needs

Do you have food allergies or sensitivities? *

Dietary preferences (check all that apply): *

No preference

Vegetarian

Vegan

Pescatarian

Gluten-free

Dairy-free

Nut-free

Halal

Kosher

Low FODMAP

Other

Anything else we should know about your relationship with food or nourishment this weekend?

Health, Safety, and Accessibility

This helps us support you. We share only with facilitators on a need-to-know basis.

Do you have any medical conditions, injuries, or mobility considerations we should account for?

Are you currently pregnant or postpartum? (optional)

No

Yes

Prefer not to say

Mental health support: do you have anything we should be aware of to hold you safely?

Are you currently under the care of a mental health professional? (optional)

No

Yes

Prefer not to say

Any medications or medical devices we should know about in case of emergency? (optional)

Accessibility needs (check all that apply):

Stairs are difficult

Need close parking access

Prefer chair options for movement practices

Need fragrance-free(ish) environment

Hearing support (please explain)

Other

Consent, Boundaries, and Group Container

In group experiences, what helps you feel safe and supported?

Any boundaries you’d like us to know about? (touch consent, sharing, pacing, etc.)

Sizing and Outfit Notes

Clothing & Shoe Size (for planning and/or retreat swag): *

Any outfit considerations for the witchy photoshoot? (colors you love, parts you want to highlight, anything to avoid)

Photo/Video Release

We may capture photos/video for memories and future retreat marketing. Your comfort comes first. Please select one: *

YES, you may use my image for marketing and social media.

YES, but please do not tag me or use my name.

NO, please do not use my image for marketing (candids okay for private memories only).

NO photos/video of me at all (we will do our best to honor this).

Final Notes

Anything else you want us to know to make this retreat magical for you?

Acknowledgements

Please accept each line to acknowledge:

I understand this retreat is a wellness/spiritual experience and is not medical or psychological treatment.

I agree to take personal responsibility for my participation and to communicate my needs and boundaries.

I understand that individual experiences may vary and no specific outcomes are guaranteed.

I agree to respect confidentiality within the group container.

I understand that some activities may be physically active (ex: goat yoga, equine experiences) and I will opt out if needed.

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