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Liberation Northern California - Oct 27-Nov 1, 2023 - Registration

 

This could be Stacy, Philippe, an assistant, or someone else. If there's no one in particular, please write "no"

Contact Information

As shown on your passport
As shown on your passport
Please use the email address you'll want us to use to communicate with you.
Please include country code and indicate both numbers if they are different.
We will have a Private Facebook group with important information about the event and communication between participants, organizer and faculty.  If you are not on Facebook, enter "N/A".

Additional Information

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Tell us more about the heritage / background that matters most to you.
Name, Phone and Email

Tuition

The final price will include an additional 3% to cover fees from our payment processor.  If you'd like to use an alternative payment method (like Zelle) to avoid the fees, please use THIS LINK for payment options and choose the "alternative payment method" option below. If the Full Price Tier or Repeater Tier are full, you will be added to a wait list for that tier- we will let you know in a confirmation email if that is the case.

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★ Assistants: Graduates only. Please fill out the Application here.
Include the dates, location and faculty.

Accommodations

For this training it is preferred that couples and family members do not stay in the same room.  

Most people will be in a twin bed in a room shared with 1-3 other people.  There is a choice of indoor accommodations in structures close to the training space or glamping tents shared with 1 other person in the middle of a beautiful meadow about a 10-15 minute walk from the training space (there is a shower house, wifi, electricity, and kitchenette in the camping area).

Glamping tents all include wifi, electricity, bedside heater and table with lamp, comfortable beds with mattress heaters and linens.

If you would like a private space for an additional $450 or a larger bed for an additional $250, please indicate that below and you will be added to a wait list.  We will know more about availability of this option closer to the training.  If a private space opens up for you, we will let you know and $450 will be added to your balance due.  

There are limited spots for camping with your own gear (5 available) and for RV's (4 available).  RV's must be 25' or less.  There are no hookups available.  If you bring an RV, you must let us know since space is limited and we will ask that you plan on not using a generator.
Share the names of anyone you know (who is going to the training) who you would like to room with, and we will do our best to accommodate you. For this training it is preferred that couples and family members do not stay in the same room.
Let us know if you have any special needs or requests.  Also please let us know if you snore loudly.
Would you like to arrive the night before the retreat for an additional $210 fee? This includes accommodations and dinner, as well as breakfast and lunch the next day.

Health

Check all that apply

Mental Health History

Tell us about your life experience so we can better serve you.  These answers are kept confidential. It is not recommended to attend a workshop with deep inner child work if you have an active issue with substances and/or you have been actively suicidal in the past year. If you have a lot of life instability it is better to defer doing this workshop when you feel more stable in your life. Please be honest so we can support you in deciding if this workshop is the right fit for your at this time. It is also recommended that you have completed foundational therapy.

Please elaborate
Please elaborate

Workshop Experiences/ Information

This workshop is for those that have completed foundational personal work. It is recommended (not a deal breaker) that this not be your first intensive workshop experience. Please come resourced and ready to actively participate. The tools in this workshop we use daily and have a great impact on your nervous system. It is highly recommended you have a few days following the workshop to land back in your life. There is also a more intensive academic portion of this workshop with teaching pieces 45 minutes per day. The experiential portion of the workshop (exercises and rituals) are woven into the fabric of the training. Come ready to learn! Come ready to deprogram what is not you!

Community Connections

Final Pieces

Release of Liability

Exquisite Dark Love - Acknowledgement and Agreement for Assumption of Risk, Waiver, Release, and Consent for Participation in Exquisite Dark Love events

In consideration of the benefits of participation in Exquisite Dark Love events, and Exquisite Dark Love-affiliated events, I enter into this agreement and hereby acknowledge and agree as follows:

I. Definitions: ”Activities" shall mean all programs, classes, training and instructional sessions, events, and exercises offered by Exquisite Dark Love, Philippe Lewis or any other entity, organization, or individual in conjunction with Exquisite Dark Love, Philippe Lewis. “The Released Parties” shall mean Exquisite Dark Love, Philippe Lewis or any other entity, organization, or individual in conjunction with Exquisite Dark Love, Philippe Lewis. "Use of the Facilities" shall mean the presence on or admission to the premises or site where the Activities occur (whether indoors or outdoors) for participation, observation, instructional or any other purpose, use of the equipment, or any other property supplied by Exquisite Dark Love, Philippe Lewis or any other  individual acting in conjunction with Exquisite Dark Love.

II. Assumption of Risk: I acknowledge and understand that my participation in the Activities or Use of the Facilities will require varying degrees of physical exercise, contact with other persons, and exposure to various conditions of the Facilities.   I understand that such exercise, contact and exposure inherently carry the risk of serious injury and damage to my person or property, including without limitation, loss, death, or disability. I am aware that the usual risks, hazards, and dangers of injury, death, or disability, and loss increase when the activity takes place outdoors or when I or others consume intoxicating substances. I acknowledge that my participation in the Activities is strictly voluntary, and I acknowledge that am in good health and physical condition. In spite of the risks and dangers, I voluntarily assume any and all risks, known or unknown,anticipated or not, including but not limited to risks as listed above, related to participation in the Activities and Use of the Facilities.   As such, I understand and agree that The Released Parties shall not be liable for any injury, loss or claim, including without limitation, personal, bodily, or mental injury, death, disability, economic loss, property damage, or any other damage suffered by me in connection with my participation in the Activities or Use of the Facilities, whether resulting from the acts, negligent or otherwise, of The Released Parties or anyone else's participation in the Activities or Use of the Facilities.

III. Waiver & Release: I  hereby agree, on behalf of myself and my next of kin, heirs and representatives, to release and forever discharge, and promise not to sue, The Released Parties from any and all claims, actions, damages, liability, costs, expenses, and attorney’s fees which are related to, arise out of, or are in any way connected to my participation in the Activities or Use of the Facilities, whether or not the same are caused by the acts or omissions, negligence or otherwise, of any Released Parties  or anyone else participating in the Activities or Use of the Facilities. By this agreement, it is my intention to surrender and waive any rights to sue or exercise any legal right to seek damages from Exquisite Dark Love, Philippe Lewis or any other entity, organization, or individual in conjunction with Exquisite Dark Love, Philippe Lewis.  

IV.  Pay Costs for My Own Misconduct: I agree to defend, indemnify, hold harmless and protect the Released Parties  from and against any and all claims by another person against a Released Party, including payment of attorney’s fees, which are the result of my own alleged negligence or affirmative misconduct during or arising out of my participation in this Activity, including travel to and from or before, during or after the Activity. If any Released Party incurs any of these types of expenses, I agree to reimburse the said party on demand.

V.  Medical Condition: Persons with any known or suspected medical conditions should consult first with their doctor before engaging in the Activities, and before using any Facilities and should not engage in the Activities or use the Facilities if subject to any medical condition that might impact their ability to safely do so.  


VI.  Acknowledgements: 
Despite possible group agreements suggesting, advising, recommending, or requesting that participants refrain from being under the influence, I acknowledge that participants may be under the influence and therefore especially susceptible to causing or contributing to incidents, or incurring incidents or injuries of various kind. I acknowledge that if any pools or water features are present there shall be NO JUMPING OR DIVING INTO POOLS ALLOWED WHATSOEVER and no running, rough play or horseplay of any kind is appropriate at any time.  I understand the Facilities may have various potential hazards, including stairs, uneven walking surfaces, dimly lit or non-lighted areas, steep hillside and decks and balconies and associated risks. I acknowledge that I DO NOT REQUEST OR NEED ANY FURTHER WARNINGS OR CAUTIONS about known or unknown, obvious or hidden hazards or dangers that may be present at the Location and that I will take responsibility for my own safety, and WILLINGLY ASSUME ALL RISKS related to the Activity or my presence at the Location.

VII.  Miscellaneous:
(a) This Agreement shall be governed by and construed under the laws of the State of California, U.S.A.
(b) This Agreement shall be effective indefinitely and shall apply to all contemporaneous agents, representatives, officers, directors, principals, successors, affiliates. subsidiaries, employees, and all other persons acting on their behalf of any Released Parties, including but not limited to Exquisite Dark Love, Philippe Lewis, or any other entity, organization, or individual assisting in the Activities or Use of the Facilities, which persons shall be express third-party beneficiaries of this Agreement

I hereby certify that I am over 18 years of age. I have carefully read the foregoing of this document and acknowledge that I understand and agree to all of the above terms and condition.

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