Emergency and Waiver Form for Retreat

Emergency Contact & Waiver Form

Please complete and eSign the form below
Your Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contact Name *

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Any food allergies, please specify
Any mobility limitations, please specify
Personal Insurance

I agree to take out/ensure that I have adequate insurance to include trip interruption & cancellation, baggage and health medical coverage for travel to Costa Rica for travel to and from, and for the duration of the Retreat. I understand this is my responsibility and that I have been advised to ensure that I have coverage in place. I take full responsibility for ensuring my fitness to travel and will check any concerns with my Healthcare Practitioner.

Liability

I indemnify and save harmless Lura Shopteau and Dawn James from any and all expenses, costs, damages, suits, actions and liabilities arising from all loss or damage to personal property, personal accident, injury, sickness or death while occupying Hermosa beach Hotel and its grounds. This waiver of liability applies during the accommodation dates at the property.

During my stay, I will report any concerns or unsafe conditions to Lura Shopteau and Dawn James immediately and accept liability for any breakages or damages caused by myself whether accidental, deliberate or by neglect.

I agree to conduct myself safely, comply with any house rules and follow the instructions of Lura Shopteau and Dawn James.
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Date eSigned*

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Emergency Contact & Waiver Form