Wellness Retreat Application Form

Wellness Retreat Application Form

with Kendra Boone
For a matter of both safety and courtesy, please answer the following pre-retreat questions. The information obtained will be treated as confidential and will not be revealed to any person other than Kendra and her assisitants on the retreat.
Name *

First Name Last Name
Email for newsletter and communication
example@example.com
Phone Number
Please enter a valid phone number.
Contact no. and name in case of emergency
Please enter a valid phone number.
What do you hope to gain from attending the retreat?
Do you give permission to be photographed over the retreat to be used in social media and marketing?
Are you currently engaged in any physical activity?
Do you meditate or have you practiced any relaxation techniques?
Medical information: Do you have any of the following now or in the past?

High Blood pressure Low blood pressure Heart stroke condition Diabetes Epilepsy Arthritis Asthma or breathing difficulties Back pain Regular headaches Autoimmune disorders Are you pregnant or planning Clinical depression Anxiety disorder PTSD Cancer Dizziness other
Have you undergone any recent surgery? Have you been hospitalized recently?
Are there any issues you wish to share about triggers with yoga poses/breathing/lighting etc, that you have had in the past?
Do you have any special needs or requests? eg nutrition, mobility, car pooling etc
Are you currently taking medication on a regular basis?
In my opinion there is no medical reason why I should not take part in the Wellness Retreat. I acknowledge that this retreat is taking place on a property in nature that is my responsibility to be careful unaware of the risks I am taking whilst walking, during yoga or undertaking other activities whilst on the property. I declare that I will take full responsibility for myself during my time at the retreat and agree to inform organisers if I require any assistance or support or other services to enable me to stay safe and well whilst attending the retreat. I also take full responsibility for my actions and cover the costs of repairing any damages that I cause. I expressively waver any claim I may have against Kendra Boone/Murrah Dream Retreat/Heartspace Retreat, for any injury, illness mishap or loss sustained by me during my attendance. I understand that all safety precautions will be observed but I agree to accept responsibility for any injuries that may be sustained whilst taking part in the yoga classes and any injuries sustained on the retreat grounds. *

Clear
Investment

Please pay via bank transfer to the account below.

BSB: 923100 Account: 31620858 or pay by credit card below.

Email confirmation of payment: restore@kendrahealingarts.com

Make sure you submit this form, click the orange 'submit' button at the bottom of the form.
Date signed *

Month Day Year
Date
Wellness Retreat Cancellation and Refund Policy

Sometimes things don’t go to plan and in the current climate we will be as flexible as we can.

Cancellations by you one month prior -

A full refund (minus 10% admin fee) will be offered for cancellations 4 or more weeks prior to the event.

Cancellations by you within one month prior -

If cancellation occurs within one month of the start date no refund will be given unless a replacement participant can be found to take your place. In the case of a replacement participant being found, an admin fee of $200 will be charged.

Disruption due to unforeseen circumstances -

In the event the retreat needs to be cancelled, you will receive a full refund

Payment choices

To book your place on the retreat, an instalment or full payment needs to be received upon booking.

If paying by instalment, the first instalment is to be paid upon booking. The remaining amount must be paid by one month prior to the start date of the retreat, or the place may be forfeited, in which case refund policies apply as above. You can choose to pay your instalments how you like.

Fees paid can be transferable to family and friends but not transferable to other course of offerings.

Wait list deposit

To be on the waitlist, a $50 deposit will be requested and refunded to you if you are not offered a place if someone cancels. Retreat places may be offered right up to the retreat start, and you will need to be ready to arrive at short notice. The $50 is not refunded if you do not take the place offered.
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