Retreat Registration Form

Retreat Registration Form

Nervous System Reset Retreat for Women | Domaine des Sept Vallons, France | May 17–22, 2026
Guest Information
Name

First NameLast Name
Birthdate

MonthDayYear
Date
Email
example@example.com
Home Number
Cell Number
Address

Street Address

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

MonthDayYear
Date
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 etc…)
What inspired you to come to this retreat?
All options include 5 nights of accommodation, three nourishing meals per day, and all retreat activities, workshops, and yoga sessions.
prevnext( X )
Private RoomSpacious and elegant room with a full-size bed and a private en-suite bathroom. Perfect for those who desire quiet, privacy, and personal space throughout the retreat.
$1,799.00



Shared RoomA beautiful shared room for two with two single beds and a private bathroom.Ideal if you're coming with a friend or are open to being paired with another participant.
$1,499.00



Retreat Dorm - Lower Bunk BedShared Bunk Room with 4 beds per room. Bright, welcoming rooms with bunk beds and a shared bathroom (shared between two rooms). A cozy and budget-friendly option for those who love the community vibe.
$1,299.00



Retreat Dorm - Upper Bunk BedShared Bunk Room with 4 beds per room. Bright, welcoming rooms with bunk beds and a shared bathroom (shared between two rooms). A cozy and budget-friendly option for those who love the community vibe.
$1,199.00 Quantity



Non-refundable DepositReserve your place now with a non-refundable deposit of $499 USD. The remaining balance must be paid in full by December 1st, 2025. (We'll follow up with payment reminders and options for completing your balance.) Please select the room option you would like us to save for you:
$499.00



Total

$0.00
Roommate Preference (for Shared Room or Retreat Dorm only): If you selected a Shared Room or Retreat Dorm option and already know who you’d like to share with, please list their name(s) below. If you're coming solo or don’t have a preference, simply leave this blank—we’ll thoughtfully pair you with another participant.
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY
Nervous System Reset for Women Retreat
May 17–22, 2026 – Domaine des Sept Vallons, France
Hosted by Isabel Churchill

By registering for this retreat, I acknowledge and agree to the following terms and conditions:

1. Health & Responsibility
I understand that this retreat includes physical and emotional practices such as yoga, breathwork, meditation, aromatherapy, and energy healing. I affirm that I am in good physical and mental condition to participate, and I take full responsibility for my own wellbeing during the retreat.

I agree to inform the retreat host of any relevant injuries, health conditions, or limitations prior to the start of the retreat. I understand that this retreat is not a substitute for medical or psychological treatment.

2. Assumption of Risk
I voluntarily assume all risks related to my participation in this retreat, including any physical or emotional discomfort, personal injury, illness, or property loss. I release Isabel Churchill, her collaborators, and the retreat venue from all liability, except in cases of gross negligence or intentional misconduct.

3. Retreat Environment
I understand that this is a shared group experience. Respectful behavior and a willingness to participate in a safe, supportive community are required. The facilitator reserves the right to dismiss any participant whose conduct disrupts the harmony or wellbeing of the group, without refund.

4. Refund & Cancellation Policy
I acknowledge that all retreat payments are non-refundable after 7 days from the date of registration.
- Cancellations made within 7 days of registration are eligible for a full refund.
- Cancellations made more than 7 days after registration are non-refundable, unless the host is able to fill the vacated spot. If the spot is filled, a partial or full refund may be granted, minus a $100 administrative fee.
- No refunds will be issued for non-attendance due to illness, travel delays, or personal emergencies. I understand that travel insurance is strongly recommended.
If the retreat is cancelled by the host due to unforeseen circumstances, I will be offered a full refund or credit toward a future retreat.

5. Deposit and Final Payment Policy
If I choose to reserve my spot with the $499 deposit, I understand that:
- This deposit is non-refundable after 7 days from the date of registration.
- My retreat spot is not fully confirmed until the remaining balance is paid in full.
- The final payment is due no later than December 1, 2025.
- If I fail to pay the full balance by this date, my space may be released and I may forfeit my deposit unless prior arrangements have been made in writing.
6. Photography & Media Release
I grant permission for group photos and videos to be taken during the retreat for future marketing purposes. I may opt out of being photographed by notifying the host in writing before the retreat begins.
Acknowledgement

By submitting this form, I confirm that I have read, understood, and agreed to all terms outlined in this Agreement. I acknowledge that I am participating voluntarily and at my own risk.
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