Refresh & Renew Jungle Retreat Registration Form

We recommend booking flights to Cancun International airport, this is the airport we will be coordinating transfer to/from. Onze is about an hour and a half from Cancun Airport. If you would prefer to fly in/out of another airport, please coordinate your own transfer.

Please remember to check your passports to ensure they are up to date.

Guest Information

Name*

First NameLast Name

Birthdate

Date

Email *

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

Phone Number*

Alt. Phone Number

Have you practiced Yoga before?

If yes, what type of yoga have you practiced?

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.)*

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

Date

If there is someone you are signing up for this retreat with, please put their name below. If not, just put N/A

Are you bothered by scents (essential oils, incense, perfumes etc.)? If yes, please let us know the details.

Do you have any special dietary requirements? (eg: gluten-free (please specify if you are celiac), allergies, vegan, vegetarian, no fish, etc…)*

What/ Who inspired you to come on this retreat?

What type of sleeping arrangements would you prefer?

Gender (for room assignments – optional):This helps us match shared accommodations respectfully.

Would you like to hear more about our additional spa/wellness treatments?

YesNoMaybe, send details

We will be coordinating shuttle transfers from Cancun Airport 6 weeks prior to the retreat, would you like to be included in the transfer coordination?*

Yes, I will not plan my own transferNo, I will coordinate my own transfer

Would you like to pay in full now or have a payment plan?*

Payment plans are 4 payments first $250 non-refundable deposit, 2nd payment is 30% in 30 days 3rd is 25% after 60 days and 4th payment is remaining balance 30 days before retreat

Please select your payment option*

All credit payments have an additional 3% charge and $0.30 charge per transaction.

Would you like to remain on our mailing list about future retreats?

YesNo

Please ask any questions you may have!

If you have a coupon code, enter it below

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 and wellness related information and instruction. 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 or at any point during the retreat I feel discomfort or pain, I will inform and seek assistance from the instructor and/or retreat host.

I may rest at any time during the class and throughout the retreat. 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 fitness classes or workshops.

I recognize that it is my responsibility to notify my teacher of any serious illness or injury before the retreat and 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 and while attending this retreat.

I understand that the $250 deposit for the retreat is final with no refunds and the balance of my payment is due either at that time or through a payment plan. All payments must be received 30 days prior to the retreat. Cancellation fees will apply due to associated costs such as the food service, accomodations, retreat activities, workshops etc. I agree that all cancellations made less than 30 days in advance of the retreat be paid in full and that I may transfer my spot to another person. Cancellations prior to 30 days before the retreat will be refunded in full less the deposit.

Exclusion of Participation: In the unfortunate circumstance, if a guest conceals physical and/or health issues, is unfit, and/or causes disruptions that endanger the provision of the service and/or the health of other participants,facilitators, or equipment the guest can be excluded from the participation of the Retreat after an initial warning. If the situation arises, the contract will be terminated without further notice, already paid costs are non-refundable and incurring costs are to be paid by the guest.

Travel Costs/Weather: In the unforunate circumstance of flight delays and/or cancellations, please notify the retreat host as soon as possible. In the unlikely event of flight delays and/or cancellations and/or inclemental weather a refund will not be issued, special circumstances may exist and will be dealt with in a case by case basis.

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.

Signature*

Date Signed*

Date