We invite you to fill out this form with openness and honesty, as it helps us ensure that this sacred weekend aligns with your intentions and supports your unique journey.

In this application, you’ll share a bit about yourself, the challenges you’re navigating, and how you desire to feel by the end of our time together. There are no right answers—just your truth.

Energetic & Legal Boundaries
of This Sacred Space

By completing this application, you honor both the spiritual and legal container of this retreat. While this experience is designed to support emotional growth, connection, and personal transformation, it is not a substitute for licensed therapeutic, medical, or psychological care, nor does any legal advice or discussions that occur at the retreat create an attorney-client relationship or substitute for obtaining legal advice from your attorney regarding your case.

You acknowledge that you are entering this space as a sovereign being, fully responsible for your well-being—physically, mentally, emotionally, and energetically. All practices shared are for educational and spiritual exploration only.

This retreat holds a specific frequency and intention. We reserve the right to lovingly decline applications that may not align with the energy or capacity of the container.

Name *

First Name

Last Name

Email *

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact (name, relationship, phone number) *

Is there anyone you'd like to room with? Please put name(s) here *

What room are you choosing? *

Shared Room – Single Bed: $2,399

Shared Room – Double Bed: $2,699

Private Room: $2,999

How would you like to setup payments? *

lease choose your preferred payment method below. We offer flexible options for both full and installment payments. Note that credit card payments include a small processing fee.

Pay in Full (Venmo, PayPal, Zelle)

Pay in Full (Credit Card – fee applicable)

Installment Payments (Venmo, PayPal, Zelle)

Installment Payments (Credit Card – fee applicable)

Dietary Information

None

Vegetarian

Vegan

Gluten-Free

Dairy-Free

Dietary Information: Any allergies or other needs?

(Please Indicate)

Any special accommodations or access needs? *

Where are you in the divorce process? *

Do you have children? If so, how many and their ages: *

What do you feel you need the most support with in this moment? *

What do you feel you need the most support with respect to the legal process? *

What led you to wanting to attend this retreat? *

Is there something you hope to release during this experience? *

Is there something you wish to call in or manifest? *

How do you want to feel when the weekend is complete? *

Are you comfortable sharing in group settings, or do you prefer personal reflection? *

Is there anything else you'd like us to know going into our time together? *

We may use quotes from your feedback for marketing purposes, and we’d love to highlight your experience. May we use your name? *

Yes, it's ok to use my name.

I prefer not to use my name.

I acknowledge I am participating in physical classes and workshops offered by Journey Within and its facilitators, during which I will receive information and instruction, including but not limited to, breathing, movement, ecstatic dance, and stretching.

I agree

I recognize that some of the offerings requires physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. Furthermore, I agree to inform any practitioner, of any movements that I feel I cannot safely perform and will not perform any movement that I feel is likely to cause injury to myself.

I agree

I represent and warrant that I have accurate and complete medical and health information, that I am physically fit and have no medical condition that would prevent me from participating in the retreat. Additionally, I agree to inform the facilitator of any limitations or medical conditions that affect my experience.

I agree

I understand that the resort and Shumsha Hanif-Cruz assume no responsibility for injuries, damages, theft of, or loss of valuables in rooms or on or off retreat grounds.

I agree

I agree to assume all risks associated with the Journey to Liberation retreat in any way. I have read the above release and waiver and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

I agree

As a retreat participant, I agree that any videos, photos, or written transcripts produced from this retreat may be distributed, and I shall not receive compensation for such distribution. I agree to the use of my portrait and photograph for educational or promotional purposes. I further agree that my participation in the retreat confers upon me no right to use, copyright or ownership.

I agree

I understand that my $500 deposit, along with this application, secures my space at the retreat. I agree to pay the remaining balance via custom bank transfer or credit card, with full payment to be received no later than September 19, 2025.

I agree

I understand I must arrange my own transportation to and from Westerbeke, and I should arrive no later than 4 p.m. on Friday, October 3, 2025 and depart no later than 3 p.m. on Sunday, October 5, 2025.

I agree

Your application has been received with gratitude.

We honor your courage in saying yes to yourself and for sharing your truth with us. Our team will review your responses with care and intention. If your energy aligns with the container, you’ll receive a follow-up email with next steps and payment options within 3–5 business days.

Until then, take a moment to acknowledge the version of you that is ready for deep rest, connection, and remembrance.

We look forward to the possibility of welcoming you into this sacred gathering.

With warmth,

Shumsha Hanif-Cruz

Questions? Send us an email.

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Home About Retreats Learn Connect Disclaimer

*Attending a retreat hosted by Shumsha Hanif-Cruz, Esq. shall not be construed as, nor create, any attorney-client privilege, unless a specific agreement to the contrary is signed by the parties.

Journey to Liberation

Retreat Participant Application

Energetic & Legal Boundaries of This Sacred Space

Questions? Send us an email.

Energetic & Legal Boundaries
of This Sacred Space