Women's Retreat Registration Form

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BYOT ~ Non-Refundable Deposit $250 $ 250.00

FULL-PRICE $950 This option gives you a bit more flexibility with your site choice. You many bring your own tent (no larger than 3person) and station in on one of our many spaces. *** INCLUDES AIRFARE FROM SAN JOSE AIRPORT TO PUERTO JIMENEZ ***** Balance will be billed by 12/31/2021

SHARED TENT ~ Non-Refundable Deposit $ 250.00

FULL-PRICE $1,075 This option is an economical way to enjoy the retreat, especially if you like sharing space. **** INCLUDES AIRFARE FROM SAN JOSE AIRPORT TO PUERTO JIMENEZ ***** Balance will be billed by 12/31/2021.

DOUBLE TENTS ~ Non-Refundable Deposit $ 250.00

FULL-PRICE $1,175 Sharing a tent allows you some privacy, as most retreat guests travel in pairs. Our Double tents are actually 3-person tents, to allow to extra comfort *** INCLUDES AIRFARE FROM SAN JOSE AIRPORT TO PUERTO JIMENEZ ****** Balance will be billed by 12/31/2021

SINGLE TENTS ~ Non-Refundable Deposit $ 250.00

FULL-PRICE $1,275 Having a tent to yourself is a preferred way for many. You may be attending the retreat for inner reflection, and need the space for moments of solitude. Our Single tents are actually 2-person tents, to allow to extra comfort. *** INCLUDES AIRFARE FROM SAN JOSE AIRPORT TO PUERTO JIMENEZ ****** Balance will be billed by 12/31/2021

Total $ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Guest Information

Name

First Name Last Name

Email (Please double check spelling)

example@example.com

Birthdate

Date

Home Number

Area Code Phone Number

Cell Number

Area Code Phone Number

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Emergency Information

Emergency Contact's Name

First Name Last Name

Phone Number

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Have you practiced Yoga before?

If YES, what type of yoga have you practiced?

Do you have any health limitations or physical injuries? Please indicate if you have any major health issues (ex high/low blood pressure, arthritis, asthma, diabetes, seizures, osteoporosis, etc.)

Gender

Male Female

Women: Are you pregnant or is there any possibility of being pregnant? If YES, please indicate your due date

Are you bothered by scents (essential oils, incense, perfumes etc.)? If yes, please let us know the details.

Do you have any special dietary requirements? (eg: gluten-free (please specify if you are celiac), allergies, vegan etc…)

What inspired you to come to this retreat?

AGREEMENT OF RELEASE AND WAIVER OF LIABILITY I hereby agree to the following: As I participate in activities offered by the hosts and special guests, I understand that the offerings of this retreat are not a substitute for medical attention, examination, diagnosis, or treatment. I will receive fitness related information and instruction. I recognize that all exercise programs require physical exertion that may be strenuous and may cause physical injury and I am fully aware of the risks and hazards. If at any time during the activities I feel discomfort or pain, I will inform and seek assistance from the teacher. I may rest at any time during the class and over the weekend. I will listen to my body and respect its limits on any given day. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any activity program. I represent and warrant that I am physically fit and I have no medical condition that would prevent my participation in fitness classes or workshops. I recognize that it is my responsibility to notify my teacher of any serious illness or injury before every class. I accept that neither the instructors, nor the hosting facility, are liable for any injury, or damages, to person or property, resulting from my participation in this reatreat. I understand that the $75 deposit for the retreat is final with no refunds and the balance of my payment is due by January 24, 2020. Cancellation fees will apply due to associated costs such as the catering service, accomodations, special guests, swag etc. I agree that all cancellations made less than three weeks in advance of the retreat be paid in full and that I may transfer my spot to another person. Exclusion of Participation: In the unfortunate circumstance, if a guest conceals physical and/or health issues, is unfit, and/or causes disruptions that endanger the provision of the service and/or the health of other participants,facilitators, or equipment the guest can be excluded from the participation of the Retreat after an initial warning. If the situation arises, the contract will be terminated without further notice, already paid costs are non-refundable and incurring costs are to be paid by the guest. I have read the above release and waiver of liability and fully understand it’s contents as well as the Refund/Cancellation Policies. I voluntarily agree to the terms and conditions stated above.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

"Self-Care ~ Self-Love" Retreat for Women