Weekend Retreat to Andalucia, Spain Registration Form

Weekend Retreat to Andalucia, Spain Registration Form
Guest Information
Name

First NameLast Name
Birthdate

MonthDayYear
Date
Email
example@example.com
Mobile Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information
Emergency Contact's Name

First NameLast Name
Phone Number
Have you practiced Yoga before?
Add more information re previous yoga experience here (optional)
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

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

MonthDayYear
Date
Do you have any special dietary requirements? (eg: gluten-free (please specify if you are celiac), allergies, vegan etc…)
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

I hereby agree to the following:

As I participate in activities offered by the hosts Brigitte and Brian Riley, I understand that the offerings of this retreat are not a substitute for medical attention, diagnosis, or treatment.

I will receive yoga/fitness related information and instruction. I recognize that all programs 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 yoga classes.

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 retreat.

I understand that a non-refundable deposit of £175 is required to secure my booking, and that 7 months before the retreat 20% of total payment is required. Then 4 months prior to the retreat the remaining balance will need to be paid in full.

I understand that once my booking has been made, my place is non-refundable or that I can transfer my place to another person.

I also understand that Airfare, airport transfers, extra excursions and travel insurance are not included. I also understand that I am advised to purchase full trip insurance to protect myself against illness, emergencies and changes in my circumstances.

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.
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