Sacred Plant
Medicine Experience –
Interest Form

This intimate 6-days/5-nights experience (September 17-22) is for those who feel called to deepen their healing, awaken inner wisdom, and reconnect with the sacred. If you're feeling the nudge, please complete this form. I'll personally reach out with more information and to invite you to book if this is aligned for you.

First Name *

Last Name *

Email *

Phone *

Address

Street Address *

City *

State *

Country *

Postal code *

What draws you to this sacred plant medicine experience? *

Have you ever participated in a plant medicine or other ceremonial experience before? *

Yes

I’m new but curious

If yes, feel free to share anything about your past experience(s). *

What intentions, questions, or healing are you currently holding in your heart? *

Are you available to be fully present for the full experience from Wednesday, September 17 to Monday, September 22 (including overnights)? *

Yes

Not sure yet

Is there anything else you'd like to share, or any questions you have for me before we connect? *

NON-DISCLOSURE AND CONFIDENTIALITY AGREEMENT

Effective Date: *

This Non-Disclosure and Confidentiality Agreement (“Agreement”) is entered into by and between Carrie Drinkwine, individually and/or through her designees, facilitators, contractors, or affiliates (hereinafter “Host”), and the undersigned participant (hereinafter “Participant”). Collectively, Host and Participant may be referred to as the “Parties.”

1. Purpose

The Host is offering Participant access to private, sensitive, and proprietary information regarding the Return to Source Sacred Soul Journey plant medicine ceremony (“Ceremony”). This information includes all steps of inquiry, preparation, participation, integration, and follow-up. The purpose of this Agreement is to ensure that all information connected in any way to the Ceremony remains strictly confidential.

2. Confidential Information

For purposes of this Agreement, “Confidential Information” means any and all non-public information disclosed, whether oral, written, visual, digital, or experiential, at any stage of interaction with Host, including but not limited to:

Websites, URLs, booking links, intake or registration forms, questionnaires, and payment processes;
Ceremony location(s), travel details, and logistical arrangements;
Teachings, methodologies, processes, and frameworks used by Host or her designees;
Experiences, perspectives, or personal disclosures made by Host or other participants;
Materials, instructions, or resources provided in preparation for, during, or after the Ceremony;
Any and all communications, including but not limited to phone calls, emails, text messages, social media exchanges, or video sessions related to the Ceremony.

Confidential Information also includes the fact of participation itself in the Ceremony, unless expressly authorized by the Host.

3. Obligations of Participant

Participant agrees to the following obligations:

a. Strict Non-Disclosure: Participant shall not disclose, share, transmit, publish, or make available any Confidential Information to any third party, whether directly or indirectly.

b. No Recording or Duplication: Participant shall not record, screenshot, copy, replicate, or otherwise capture Confidential Information in any form (including through AI transcription tools such as Otter, Fireflies, or similar), without Host’s express prior written consent.

c. No Public Reference: Participant shall not reference, describe, or allude to the Ceremony, Host, or Confidential Information in any form of public or private media, including but not limited to social media posts, blogs, podcasts, articles, or digital communications, without Host’s prior written consent.

d. Internal Use Only: Participant shall use Confidential Information solely for personal participation in the Ceremony and for no other purpose.

e. Ongoing Obligation: These confidentiality obligations shall survive indefinitely beyond participation in the Ceremony and remain binding upon Participant.

4. Legal Remedies

Participant acknowledges and agrees that any breach of this Agreement will cause irreparable harm to Host for which monetary damages may be inadequate. Accordingly, in addition to any other remedies available at law or in equity, Host shall be entitled to:

Immediate injunctive relief to prevent or curtail any actual or threatened breach;
Recovery of actual, consequential, and special damages, including loss of business opportunities;
Reimbursement of all attorney’s fees, court costs, and related expenses incurred in enforcing this Agreement.

Participant further understands that breach of this Agreement may result in removal from the Ceremony, denial of participation in future opportunities, and forfeiture of any fees paid.

5. Governing Law and Venue

This Agreement shall be governed by and construed under the laws of the State of Minnesota, without regard to its conflict of law provisions. Venue for any dispute arising under this Agreement shall be exclusively in the state or federal courts located in Hennepin County, Minnesota, and Participant expressly consents to the jurisdiction of such courts.

6. Entire Agreement

This Agreement constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes any prior or contemporaneous oral or written understandings. No amendment or waiver of this Agreement shall be valid unless made in writing and signed by both Parties.

7. Acknowledgement

By signing below, Participant acknowledges:

They have read and understood this Agreement;
They are legally bound by its terms;
Participation in the Ceremony is contingent upon execution of this Agreement;
Breach of this Agreement may result in immediate legal action and permanent exclusion from Host’s offerings.

Full Legal Name *

Signature - Sign Your Full Legal Name Here *

Clear

Date of Signing *