The Oneness Quest Institute of Vision and Healing respects your privacy. Mailing addresses and email addresses shared with us are never shared with or sold to any other organization or person(s). They are for the exclusive use of Oneness Quest.
All information that you include in your medical and personal information forms is private and never shared outside of Oneness Quest, and are protected to the full extent of the law. Information requested is to provide us with a base of knowledge to help guide you to the most appropriate program for your needs, and to keep you safe and healthy within all of our programs.
Don’t forget to send the rest of your application materials in once you’ve paid your deposit.$300 non-refundable deposit if you have not already paid online. Payment is through PayPal (payments@earth-heart.net), or by personal check to Malcolm Ringwalt.
The rest of the balance will be due PRIOR to your arrival at the class via PayPal or personal check unless other arrangements are made in advance.
If you cancel your reservation in a program you have applied for at least 2 weeks before the start of the class, of the $300 nonrefundable deposit, Oneness Quest allows $150 to be transferred (one time only) to any other Earth-Heart program within 12 months of the original class application. If you do not notify Oneness Quest of your cancellation at least two weeks before the start of the class, none of the deposit is transferable.
Are you under the care of a medical professional for a current condition? If yes, please explain.
(We are available to discuss with your doctor any medical needs you might have).
Are you currently taking any medications? If so, please list medication and condition.
If yes, what are the food requirements for your medication?
Have you had any major surgery? If so, please list the reason and the date.
Have you been hospitalized recently (past 2 years)? If so, please explain.
Do you have any SERIOUS food allergies that cause medical complications?
If yes, please list them, and rate the severity on a scale of 1-10.
**(Please note that we are not always able to accommodate mild food allergies/sensitivities.
Do you carry an EPI-PEN for your food (or other) allergy?
On a scale of 1-10, how would you rate your current physical condition?
program that we should know about? Please describe.
In the event of a medical emergency, do you have medical insurance?
Are you currently under the care of a mental health professional? If yes, please explain.
Have you ever experienced or been treated for depression? Please explain.
Are you currently experiencing depression? If so, how severe?
Do you now or have you ever suffered from any kind of anxiety disorder (i.e. panic attacks, night terrors, phobias, flashbacks, etc.)? If yes, please explain.
Have you ever been the victim of violence, physical or sexual? If yes, at what age?
These questions are designed to get an idea of who our students are and what unique backgrounds you bring. We celebrate the diversity of the people who come to us. Some of you may have no experience in any of these areas, and that's perfectly fine. No prior experience is required unless specifically stated in the course description. For the retreats we offer that deal specifically with some of these skills, this will give us an idea.
Do you have a current exercise routine/ physical practice? How often? How strenuous?
If yes, what type, since when, how frequently, and how long is each session?
If yes, what type, and what is your level of experience?
Have you ever fasted? If so, what type of fast and for how long?
Have you ever done any type of pranayama / breathwork? What type?
Have you studied any type of internal energy work (i.e. chi gung, tai chi, healing, etc.)?
If so, what type and for how long?
Have you ever done a Vision Quest? How many?
Are you and adherent of any spiritual or religious system? If so, which one?
Are you happy with the direction of your life? Why or why not?
Have you ever taken classes at the Tracker School or other programs at with Earth-Heart?
Have you had any significant training, spiritual or otherwise, that you would like us to know about?
I affirm that the confidential information, which I have provided, is accurate and complete. I understand that failure to disclose this information could affect my own safety and the safety of those around me, and I agree to hold. Earth-Heart harmless if full disclosure of a preexisting medical condition has not been provided. In the event of illness or injury, consent is hereby given to provide emergency medical care, hospitalization or other treatment, which may become necessary. I understand that parts of Earth-Heart programs may be physically or emotionally demanding. I agree to accept full responsibility and assume all risks, including those caused by acts of God, injury, death, and/or loss to my person and/or property knowingly and voluntarily, realizing that Earth-Heart will take all reasonable precautions to minimize these risks.
including those caused by acts of God, received while participating in activities conducted by Earth-Heart as a student, participant, spectator, and/or visitor, or in any other manner or form, taking part in the exercises, practices, excursions, and/or demonstrations. I certify that I am physically, mentally and emotionally capable to participate in the program I have applied for despite the rigors and dangers inherent in such undertaking. I acknowledge that the use of video recorders is prohibited.
I understand that at no time during the Vision Quest program will anyone be allowed to stay in the base camp during the Quest other than the Quest protectors/staff - this includes Questers who decide to leave their Quest early. A ride will be provided by a staff member to an outside location were you can arrange hotel accomodations or an early flight home. This is to ensure the undisturbed energy in the protected Quest area for those who remain for the full 4-days and nights, and to ensure that the Quest protectors can focus 100% of their energy on those actively Questing. No refund is given for anyone who chooses to leave early.
I understand that prices, policies and course dates are subject to change without notice, and that Earth-Heart is not responsible for any nonrefundable airfare at anytime. My signature below indicates my acceptance of these terms and my desire to participate in an Earth-Heart program. I also acknowledge that should I cancel, only $150 of the $300 nonrefundable deposit can be transferred (one time only) to another Earth-Heart program within 12 months of the original application. After 12 months, it is no longer transferable. If I do not notify Earth-Heart of my cancellation two weeks before the start of the class, none of the deposit is transferable.
I release to Earth-Heart rights to use any photograph or video taken while participating in an Earth-Heart program to be used as deemed by Earth-Heart, including web site, brochure or other advertising.