Name
*
First Name
Last Name
Best email to connect with you
*
Best number to reach you
*
Once you have submitted the registration form, Jessica will be connecting with you for a brief call to go over the information and make sure that everything is in alignment!
Country
(###)
###
####
This is meant for individuals who are over 18 years of age.
*
Please confirm that you are over 18.
Have you completed Step 1?
*
Have you completed Step 1 and sent the $50 tribute to Paypal or Venmo?
Sovereignty + Self-Responsibility- wants, needs, desires, and limits
*
I recognize that I am entering into this temple space with the intention of deep transformation.
I recognize and understand that exploring my own sexuality can potentially reveal some pieces that are outside of my comfort zones.
I claim responsibility for myself and my feelings, and commit to speaking up to seek support.
Sexual history
*
Please select below if you have experienced any of the following:
Heart Medicine Shamanic Journey
*
The Heart Medicine Shamanic Journey component is one that helps in the healing of the various aspects of the Masculine-- be it in relationships, the energetic, and the masculine aspect within oneself. It is a gorgeous way to integrate the Divine Masculine again with the Divine Feminine (which is the main focus during the retreat).
To partake in this experience, please read the below:
*** IMPORTANT!!! Medications and Health Conditions ***
Certain medications must not be taken over various periods prior to our ceremony. This includes antidepressants (MAO inhibitors, serotonin re-uptake inhibitors) antihistamines, painkillers, tranquilizers, all stimulants including orally taken nasal decongestants, diet pills, medications for Attention Deficit Disorder and other meds, many prescription and some over-the-counter. Ulcers, certain heart, liver, psychiatric conditions and epilepsy present real danger in the context of the seminar. If you are taking any of the above mentioned, other prescription based medications, have experienced health conditions listed above or other serious health issues, please let me know before committing to dates. We will then discuss what is possible and the best road to your participation in the ceremony.
Full disclosure of medications and health conditions are an absolute must for joining the Circle.
The rule of thumb is that you should be off any and all medications for 15 days prior to your first work. If you have any specific questions regarding meds please email me ASAP. Full disclosure about medications is mandatory.
I must be informed if you are or have been taking any of the following:
* Antidepressants or other medications that contain MAO inhibitors and serotonin uptake inhibitors (not to be taken for 15 days prior to gathering)
* Tranquilizers (not to be taken for 15 days prior to gathering)
* Antibiotics (not to be taken for 7 days prior to gathering)
* Antihistamines (not to be taken for 5 days prior to gathering)
* Painkillers including Advil and aspirin (not to be taken for 5 days prior to gathering)
* Flu medications (not to be taken for 5 days prior to gathering)
Any other medications that are not listed let me know about ASAP.
Discretion/Confidentiality
*
I understand that this retreat weaves in aspects of sacred sexuality, shamanism, and spirituality. It is the sanctity of this space that allows for the vulnerability, release, healing, and expansion that myself and others desire to be in this world. I understand that it is important to respect what others share in the space, and that it remain confidential.
How do you want to feel at the end of the Holy Fuck S*x Magick Retreat?
*
What has been your exposure/experience with BDSM?
*
What has been your experience/exposure to shamanic journeys + medicine?
*
What are you most excited to experience during this retreat?
*
What are you most nervous about?
*
Dietary Restrictions
*
There is a term that Jessica has adopted from France called "socioplacy". It translates to the group respecting the common denominator. Meaning-- if someone is gluten free, all food will be gluten free. If someone is vegan, then all food will be vegan.
What are your current dietary restrictions?
Your sexuality
*
Share how you currently feel about your sexuality/sensuality, and how you WANT to feel.
Disclaimer
*
I am aware that a few disclaimers will be coming to me prior to the retreat to read and sign.
Have you listened to 3 audios on the retreat page?
*
Audio 1- "I invite you into the Temple of the Wild Rose..."
Audio 2- "FAQ's and considerations..."
Audio 3- "Confidentiality during immersion..."
Questions you have for Jessica?
*
Please list any questions you'd like to go over and address when you connect.
What would you like us to know?
*
Share what you feel would be helpful for Jessica to be aware of and know prior to the retreat.
Alcohol + caffeine free environment
*
I acknowledge that there will not be alcohol or caffeinated drinks during the retreat.
Cancellation Clause
*
If plans change and you are unable to attend the retreat, $500 will be held for the costs of the venue and other monies will be returned to you.
Jessica deeply cares about you receiving value for your contribution and will provide you a private 1:1 online session with you.
Which Holy Fuck S*x Magick Retreat do you desire to attend?
*
Commitment
*
I understand that this retreat has a maximum space limit of 13 women attendees.
I recognize that this is the only opportunity until summer to experience this life changing retreat!
I am submitting with the utmost faith and intention to come!
Tribute- Deposit and Balance
*
The tribute for the spiritual services The Power Priestess is $1,300. Goddess Isis has placed a value of $13,000 for this Retreat experience.
Please confirm which option you feel you are able to do:
Statement of consent
*
You are entering into a sacred temple space that weaves in elements of spirituality, sexuality, and shamanism.
This is a statement saying that you are consenting to the participation in plant medicine, physical touch, energy release. All of this is done consensually and no one has to do anything they do not want to do.
If at any point there is an activity or exercise that you do not wish to be an active participant in, you are welcome to self-resource while staying within the space.
Sovereignty- Corona
*
In the state of AZ, gatherings are allowed. People entering into spaces come with the understanding there is a risk of contracting Corona.
You are welcome to wear a mask throughout the retreat, though it is not required.
If you are feeling symptoms that are indicative of having Corona, please do what is in the highest good for all and take care of yourself and your well being.
