Summer Camp Detailed Registration Form

Yoga Retreat Registration
Name

First NameLast Name
Birth Date

MonthDayYear
E-mail
example@example.com
Cell Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Do you have any allergies, chronic illness, or medical conditions? If yes, please describe.
Where did you hear about this retreat?
What inspired you to come to this retreat?
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

I hereby agree to the following:

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

I will receive fitness-related information and instructions. I recognize that all exercise programs require physical exertion that may be strenuous and 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 before 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 fitness classes or workshops.

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 have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

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Date
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Yoga Retreat Registration