Mother’s Day Celebration

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1 Welcome

2 Price

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$350.00 – Program Price - Full Weekend

Number of Guests:

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$600.00 – You & Your Mom - Give the Gift of Retreat

Number of Guests:

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3 People in your group

Guest 1		First Name* Last Name* Email Address* Gender Identification
Guest 1		First Name* Last Name* Email Address* Gender Identification

After completing this form, emails will be sent to everyone in your group to complete their information.

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4 Optional Items

Bed in Shared Room Friday, Saturday & Sunday

King or Queen Bed in a Shared Room (2 beds in the room)

$250.00

Select quantity

Bed for Friday, Saturday AND Sunday night

Single Bed in Shared Dorm Room (10 bunks available)

$100.00

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Private Room for Friday, Saturday & Sunday

Private Room in the Farmhouse for the weekend

$300.00

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5 Personal Information

Transparency agreement	I have read and agree to the following statement:For the safety and consideration of all involved, I will be as honest and as transparent as possible when answering these questions. If any potential medical contraindications are present, I understand that Truth is One Interfaith Church will reach out to ensure my safety and that any information I share will be held in confidentiality.
Phone Number
Full Mailing Address (including state and zip code)
Address 2
City
State/Prov.
Zip/Postal
Country
Gender Identification
Occupation
Emergency Contact Name	Please enter the name of an emergency contact who will NOT be attending the ceremony.
Relationship to Emergency Contact
Emergency Contact Phone Number
Who referred you to Truth is One Interfaith Church?
Would you like to be added to our email list?	If you are already receiving emails from us, select "No".
If you are not on our mailing list and you would like to be added, please fill out the New Member Application under the "join us" tab at truthisone.net.	https://truthisone.net/join-us/
If no, would you like to be added to our email list to receive our newsletters about upcoming events?

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6 Health Information

Do you have dietary restrictions?
Use this section to provide details about your dietary restrictions:

7 Personal Development

Have you sat with this community before?
Do you currently have a spiritual practice?
Tell us about your practice:
Do you have any concerns not indicated in this questionnaire?
List your questions here:
Additional Comments or Special Needs

8 Please Note

9 Agreements

General Waiver, Liability, and Payment *	I have read and agree to the following terms stated here:During my attendance at meditation sessions, I willingly agree to abide by these guidelines: Keep noble silence. Stay in the place designated until meditation is closed. Follow all instructions of the facilitators and helpers during meditation. I hereby agree that I always have a choice whether or not to participate, and I agree to take full responsibility for the choices I make involving this work during and after the event. I understand that this work may be physically, mentally, emotionally, or spiritually demanding, and I freely choose to enter this process. I accept full responsibility for whatever may occur, anticipated or unanticipated. To maintain the safety and trust for all participants, I hereby agree to hold this work confidential. I will reveal to no one the identity of persons participating in the event. This includes maintaining confidentiality for all facilitators, helpers, participants, and venue involved. I agree not to hold the facilitators, organizers, and the owners of the venue responsible for any damages or problems that might occur in any way connected with this meditation. If I receive individual preparation and integration sessions, I understand that the facilitators are not licensed therapists and that the support offered will vary depending on the facilitators experience and training. I agree not to hold Truth is One Interfaith Church or the facilitators responsible for any damages, harm or problems that might occur in relation to individual preparation and integrations sessions. I hereby knowingly and voluntarily assume the full risks of any physical or other injury, damage, or losses, either to myself or caused to others by me. I hereby waive the liability of, and agree to hold harmless, the organizers and facilitators of this meditation session as well as other staff, participants, and those who own and operate the venue. I release the facilitators and organizers from any responsibility for mental or physical damage to my person. I am fully responsible for the consequences of my participation before, during, and after the meditations. If I purchase something or receive additional services at the meditation such as Kambo Frog Medicine, staying an extra night, etc., or if I have a remaining balance, I understand that my credit card on file will be charged for these additional items/services/balances. All deposits are non-refundable. Refunds and credits may be given on a case by case basis and are not guaranteed. Payments must be made in full 1 week prior to the event. I understand that if I am signing up less than 1 week before the event, full payment must be received at the time of registration. If cancellation occurs within 72 hours of the event, all charges are non-refundable and the total cost of the program will be charged to the card on file. I will notify Truth is One of any illness or condition I may have that these questions might not address. It is my responsibility to inform the facilitators of any changes in health, any new conditions that may arise, and any changes in medication (including over-the-counter drugs, herbs, and supplements) between now and the meditation I wish to attend. I understand that Truth is One Interfaith Church is a registered, non-profit church in the State of North Carolina. When I register for an event, I am agreeing to become a member of Truth is One Interfaith Church.

General Waiver, Liability, and Payment *

I have read and agree to the following terms stated here:During my attendance at meditation sessions, I willingly agree to abide by these guidelines: Keep noble silence. Stay in the place designated until meditation is closed. Follow all instructions of the facilitators and helpers during meditation. I hereby agree that I always have a choice whether or not to participate, and I agree to take full responsibility for the choices I make involving this work during and after the event. I understand that this work may be physically, mentally, emotionally, or spiritually demanding, and I freely choose to enter this process. I accept full responsibility for whatever may occur, anticipated or unanticipated. To maintain the safety and trust for all participants, I hereby agree to hold this work confidential. I will reveal to no one the identity of persons participating in the event. This includes maintaining confidentiality for all facilitators, helpers, participants, and venue involved. I agree not to hold the facilitators, organizers, and the owners of the venue responsible for any damages or problems that might occur in any way connected with this meditation. If I receive individual preparation and integration sessions, I understand that the facilitators are not licensed therapists and that the support offered will vary depending on the facilitators experience and training. I agree not to hold Truth is One Interfaith Church or the facilitators responsible for any damages, harm or problems that might occur in relation to individual preparation and integrations sessions. I hereby knowingly and voluntarily assume the full risks of any physical or other injury, damage, or losses, either to myself or caused to others by me. I hereby waive the liability of, and agree to hold harmless, the organizers and facilitators of this meditation session as well as other staff, participants, and those who own and operate the venue. I release the facilitators and organizers from any responsibility for mental or physical damage to my person. I am fully responsible for the consequences of my participation before, during, and after the meditations. If I purchase something or receive additional services at the meditation such as Kambo Frog Medicine, staying an extra night, etc., or if I have a remaining balance, I understand that my credit card on file will be charged for these additional items/services/balances. All deposits are non-refundable. Refunds and credits may be given on a case by case basis and are not guaranteed. Payments must be made in full 1 week prior to the event. I understand that if I am signing up less than 1 week before the event, full payment must be received at the time of registration. If cancellation occurs within 72 hours of the event, all charges are non-refundable and the total cost of the program will be charged to the card on file. I will notify Truth is One of any illness or condition I may have that these questions might not address. It is my responsibility to inform the facilitators of any changes in health, any new conditions that may arise, and any changes in medication (including over-the-counter drugs, herbs, and supplements) between now and the meditation I wish to attend. I understand that Truth is One Interfaith Church is a registered, non-profit church in the State of North Carolina. When I register for an event, I am agreeing to become a member of Truth is One Interfaith Church.

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10 Signature of Acknowledgement

Today's Date
In typing my full name here, I acknowledge all questions and statements above:
Email newsletter	Please send me the email newsletter

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11 Donate

$	General Scholarship Fund If this is a time of abundance for you, we accept donations from the heart for our scholarship fund which helps to make these ceremonies accessible to community members who can not afford the full contribution. This fund also helps to support the general operations of the Church. We offer these scholarships to veterans, single parents, persons with limited ability and those with serious financial detriment. If you have a specific group of people that you would like your donation to support, please email us at connect@truthisone.net. Otherwise, your generous donation will go into our general scholarship fund. You can enter any amount or leave this blank if you can not make a donation at this time. Thank you!

12 Payment

Sub Total	$0

Donations	$0

Taxes	$0

50% Deposit	$0

Pay	Choose to pay a deposit or the full amount right now.

Due Now	$0 $0

First Name
Last Name
Card Number *
Card Expiration *	Month Year
Card Security Code	usually a 3 digit code on back of card