Becoming 'YOU' @ 40 Wellness Retreat Find Balance, Breath & Rejuvenate

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Birthday*

Date

Age:*

Occupation:*

What do you do for a living?

Please choose the date of the retreat you want to attend.

What are your biggest current health concerns?*

How do you rate your stress levels?*

1 is Low, 5 is High

How do you rate your energy levels?*

1 is Low, 5 is High

How do you rate your sleep quality?*

1 is Low, 5 is High

How do you rate your concentration levels?*

1 is Low, 5 is High

What are the top 3 reasons for wanting to attend this retreat?*

What are the 3 most important things to you in your life?*

Please list any food allergies and special dietary requirements:*

Emergency Contact Number

Please enter a valid phone number.

May I contact you to share event arrangements?*

*I consent to being contacted for relevant marketing (newsletters and health promoting events) and that my data be stored legally, I knowthat I will be able to opt-out at any time.

TERMS AND CONDITIONS:

Right of Admission Reserved.

Booking for the retreat does not ensure availability. Full payment confirms your booking. Your booking will be confirmed via e-mail, telephone or WhatsApp.

Cancellation terms and conditions:

Cancellations made 14 days or more before the booking date will receive a 50% refund. No refund is applicable for cancellations made within 14 days of the retreat.

Indemnity:

This indemnity applies to all persons who enter the Premises, whether as casual visitors, overnight guests, users of any of the facilities on the Premises or participating in any activity on the Premises or arranged by Dayenu Care and Wellness and Droomfontein (collectively referred to as 'the Visitor')

The Visitor acknowledges that they have read & understand this indemnity & agrees to be bound by the following:

· I enter and use the Premises, parking areas, surrounds, and stairs on the Premises & participate in any activities at the Premises entirely at my own risk.

· Right of admission is reserved.

· I warrant that I have been advised of, am aware of, and accept that I will be exposed to a variety of risks and dangers at the Premises, to risks and dangers at the Premises that have been explained to me in detail, and that I comprehend the risk and its implications.

· Such risks and activities include, without limitation, vehicles, accommodation areas, braai areas, kitchen areas, pools, ponds, dams, recreational areas, wild animals and dogs.

· I always agree to obey any warning notices and instructions of Dayenu Care and Wellness and Droomfontein.

· Visitors hold harmless and indemnify the owners, management, staff, and directors of Dayenu Care and Wellness and Droomfontein and other guests ('the Indemnified Parties') against any consequences of visiting or participating in any activities or incidents at or arranged by Dayenu Care and Wellness and Droomfontein and waive any claims I may have.

· It includes any loss of/damage to personal effects/property, any indirect, consequential, or special loss/damage, financial loss, illness, injury, harm (as defined in the CPA), or death, howsoever caused, and legal costs (attorney and own client scale) that the Indemnified Parties may incur.

We are not a medical organisation, and our recommendations should not be interpreted as a substitute for a medical consultation.
Nothing contained in the programme should be construed as medical advice or diagnosis. It is your responsibility to determine, through obtaining
appropriate medical advice, that you are fit and well and that such contents and services suit you. It is not our responsibility to do so.
Please seek advice from your doctor if you're in any way concerned about your health, are very overweight before commencing any exercise
regime, if you have an existing medical condition that could be affected by diet, if you believe you have an eating disorder, or if you are pregnant
or planning a pregnancy. The programme is not intended for those under the age of 18 without consent from a parent, doctor or guardian.

I acknowledge that any assistance that the Indemnified Parties may render or arrange is done without any admission or acknowledgement of fault or liability and as a show of empathy & goodwill.

I accepted all the terms and conditions in full.

I have read, understood and agree to the terms and conditions.*

Signature*