Retreat Registration Form

Name*

First Name (as on passport)Last Name (as on passport)

Date of Birth

Date

Email*

example@example.com

Phone Number*

Country Code Phone Number

Address

Street Address

Street Address Line 2

CityState

Post/Zip CodeCountry

Emergency Contact Info

First NameLast Name

Phone Number

Country CodePhone Number

Do you have any health limitations or physical injuries?

Enter none if you have no medical issues

Do you have any allergies

Have you practiced Yoga before?

If YES, what type of yoga have you practiced?

Comments or Special Needs

Flight Number

If unknown you can forward the details by email once you have booked

Arrival Date

Date

Arrival Time

:HourMinutesAM/PM Option

Payment for The Conscious Connection Retreat

Pay in full for June 2023 limited offer

AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

I acknowledge that I am voluntarily participating in the Conscious Connection Retreat organised by Conscious Coaching UK.

I understand that participation in the retreat may involve certain risks, including but not limited to physical injury, illness, or property loss or damage.

I acknowledge that it is my responsibility to consult with a healthcare professional before participating in any physical activities if I have any health concerns.

I further agree to indemnify and hold harmless Conscious Coaching UK, its directors, officers, employees, agents, and representatives from all claims, damages, costs, or expenses, including legal fees, arising from, or related to my participation in the retreat except for death or personal injury due to their negligence and to the fullest extent permitted by law.

I understand that the offerings of this retreat are not a substitute for medical attention, examination, diagnosis, or treatment.

By attending the retreat, I permit Conscious Coaching UK to use photos, videos, and other media of me taken during the retreat for promotional or commercial purposes. I understand and agree that the media may be edited, and I have no ownership rights in them. If I do not want my media used for promotional or marketing purposes, I will inform Conscious Coaching UK in writing before the retreat. I understand that I will not receive compensation for the use of my media.

I have read the above release and waiver of liability and fully understand its contents. I have had the opportunity to ask questions and seek legal advice if needed. I voluntarily agree to the terms and conditions as detailed in the booking form. This waiver will form part of the terms on signature and governed by the laws of England and Wales.

Confirmation

By acknowledging and signing below, I am delivering an electronic signature that will have the same effect as an original manual paper signature and will be equally as binding.

You can reveiw our privay policy here

Signature*

Guest Information