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 NameLast Name
Email for newsletter and communication*
example@example.com
Phone Number*
Please enter a valid phone number.
Contact no. in case of emergency*
Please enter a valid phone number.
Emergency contact name.
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 pressureLow blood pressureHeart stroke conditionDiabetesEpilepsyArthritisAsthma or breathing difficultiesBack painRegular headachesAutoimmune disordersAre you pregnant or planningClinical depressionAnxiety disorderPTSDCancerDizzinessother
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,Jindii Ecospa, 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 retreat deposit or in full via bank transfer to the account below today.

BSB: 313 140 Account: 124 280 98.

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*

MonthDayYear
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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