Weekend Retreat Registration Form

    Please fill out this form to register for a Weekend Retreat

    Basic Information

    Weekend Retreat Goals

    Financial Information

    Please be aware, the full cost of the Weekend Retreat must be paid one week prior to your schedule retreat.  Your non refundable deposit will secure your preferred dates.

    Emergency Contact

    Who can I contact in case of an emergency?
    Once you have read and provided your signature below, you will receive and invoice detailing the dates of your retreat and the payment option you've chosen. This invoice is required to be paid within 5 days or you will forfeit your retreat dates.
    Please contact me with any questions at 919-410-6707.

    Weekend Retreat Agreement

    I am excited that you have decided to attend a 1 0n 1 Weekend Retreat!
    Below will outline our Weekend Retreat Agreement! Your signature at the end of this document is required and indicates that you agree fully to the information below. Please review carefully.
    Weekend Retreat Contract
    Each new client to my practice is a welcome addition. We have had our introductory call with each other and determined that we are optimistic and enthusiastic about what we can accomplish together. To bring our “best selves” to the coaching relationship, it is important that we share the same understanding about how we will work together.   
     
    Basic Shared Agreements:

    The Weekend Retreat runs from Friday at 7pm (Dinner) until Sunday at 3pm. The following are included in your Weekend Retreat:
    Hotel Stay ( 2nights), 6 Meals, Personal Coaching throughout weekend, 2 Reiki Sessions, Daily Guided Meditation & Visualization Session, A Weekend Retreat Binder, and 1 Massage.

    Payment can be made by the following methods: Paying in Full or with a NON REFUNDABLE Deposit of $500 and a mutually agreeable payment plan. The Full Retreat fee is required 7 days prior to your scheduled retreat. If you are unable to pay it in full, please let me know as soon as possible so alternate arrangements can be made. I can not guarantee that your retreat will be able to be rescheduled and you will forfeit your deposit and all payments made towards the retreat cost. Please take advantage of the FREE Clarity Call to confirm that this is the right option for you.


    Statement of Intent
    All coaching services delivered by Latoya Nelson, are meant to challenge, uplift, and support you psychologically to reach your specific goals. However, coaching is not psychotherapy. If you feel psychologically stressed to the point that it is interfering with your ability to function, please let me know and I will assist you in getting connected with a professional counselor. Life coaching may augment your therapy, but the work of coaching is meant to be done when major emotional and psychological wounds are already healing or healed. In that spirit, please read the following and sign below should you agree to each statement and wish to proceed:
    • I understand that the life coaching services I will be receiving from Latoya Nelson are not offered as a substitute for mental health care. I also understand that my coach, Latoya Nelson, is not acting as a psychotherapist, and does not purport to offer mental health care during the coaching sessions.
    • I understand that my coach will maintain the confidentiality of our communications only to the extent defined by the laws of the states in which each of us resides.
    • I understand and agree that I am fully responsible for my well-being during my coaching calls, and subsequently, including my choices and decisions.
    • I understand that all comments and ideas offered by my coach are solely for the purpose of aiding me in achieving my defined goals. I have the ability to give my informed consent, and hereby give such consent to my coach to assist me in achieving such goals.
    • I hereby release, waive, acquit and forever discharge Latoya Nelson and Nelson Enterprises, their agents, successors, assigns, personal representatives, executors, heirs and employees from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of actions, omissions, or commissions taken by myself or by Latoya Nelson as a result of the advice given by Latoya Nelson or otherwise resulting from the coaching relationship contemplated hereunder. I further declare and represent that no promise, inducement or agreement not herein expressed has been made to me to enter into this release. The release made pursuant to this paragraph shall bind my heirs, executors, personal representatives, successors, assigns, and agents.
    Confidentiality Notice
    The conversations that we have within our coaching sessions are confidential and will be protected as such. Information will be shared outside of our sessions only with your written consent or in the event that a Court Judge demands it, however, the following are instances where I would be obligated by law to break our confidentiality agreement without your permission:
    • If it is assessed during your participation in coaching sessions that abuse or neglect of children or elders is occurring.
    • If in my presence you threaten to kill or harm another individual, and I am convinced that you will act on this threat, or that you may lose control of your actions.
    • If at any time during the course of our sessions, I determine that you are a danger to yourself, I will inform you of that opinion and make every effort to keep you from endangering your life. In some cases this may include notifying the police or family members.

Lotus Wellness Center
Virutal services provided to NC & VA residents
p: 919.410.6707
F: 919.800.3399