The Unbinding Application

This is a selective, intimate experience designed for individuals ready for deep personal work, emotional honesty, and meaningful change.

This is not a passive workshop. It requires presence, readiness, and investment.

Please answer thoughtfully—this helps us determine if this experience is the right fit for you.

Basic Information

First name

Last name

Phone

Preferred Method of Contact

Call

Text

What feels most stuck or heavy in your life right now?

Where do you feel like you are repeating the same patterns?

What are you hoping to shift, release, or step into through this experience?

Why does this feel important for you right now?

What usually gets in the way when you try to make change in your life?

What would you say you need most right now (for example, a break from the chaos, real tools or skill building, connection, support, etc)

On a scale of 1–10, how ready do you feel for real change? (1 = not ready, 10 = fully ready)

Why does now feel like the right time to seek support?

If accepted, are you willing to: 1. Attend both days fully 2. Be present and engaged 3. Limit distractions during the experience

Yes

If accepted, are you prepared to secure your spot within 24 hours with a $300 deposit?

Yes

The investment is $1,500. Which feels most accurate right now?

I am ready to invest

I would need a payment plan

I am not sure yet

If accepted, you will be invited to a brief call or sent next steps directly depending on fit. Anything else you’d like me to know?

Which Unbinding Experience Are You Most Interested In?

Confirmed Dates

August 24th & 25th 2026 – The Unbinding (Core Experience)

October 12th & 13th 2026 – The Unbinding for Providers

Upcoming Themed Experiences

Protected & Powerful (Self-Defense & Empowerment)

Wild & Free (Nature Immersion & Campout)

Sacred & Sovereign (Deeper Spiritual Focus)

Canna-bliss Wellness With A Twist (Plant Medicine Experience)

Other / Not sure yet

LIGHTHOUSE MENTAL WELLNESS

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