Beausoleil Yoga Retreats – Participant Intake & Waiver Form

Beausoleil Yoga Retreats – Participant Intake & Waiver Form

Beausoleil Yoga Retreats – Participant Intake & Waiver
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Relationship
Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Health & Wellness

Confidential- for retreat leader reference only
Do you have any medical conditions we should be aware of? (e.g., heart disease, diabetes, asthma, high blood pressure, etc.)
If yes, please specify and explain as necessary.
Do you have any psychological conditions (e.g., anxiety, depression, PTSD, past trauma) that may impact your experience?
If yes, please specify and explain as necessary.
Are you currently taking any medications that we should be aware of?

If yes, please list.
Do you have any dietary restrictions, allergies, or food intolerances?
If yes, please specify:
Do you have any physical limitations, injuries, or recent surgeries?
If yes, please specify:
How do you manage stress? Are there any specific triggers or challenges you’d like to share?

What are your intentions for this retreat? What do you hope to gain from this experience?

Liability Waiver & Assumption of Risk
I acknowledge that participation in Beausoleil Yoga Retreats may include physical activities such as yoga, meditation, hiking, and other wellness exercises. I understand that:

• I am responsible for my own physical and emotional well-being.

• I will inform the retreat leader of any discomfort or medical issues that arise.

• I assume all risks associated with retreat activities, including but not limited to injury, illness, or personal loss.

• I release Beausoleil Yoga, its facilitators, and all retreat staff from any liability for personal injury, loss, or damage incurred during the retreat.

• I understand that participation in this retreat is voluntary, and I have consulted my healthcare provider if necessary.

I have read, understood, and voluntarily agree to this waiver and release of liability.
Signature
Date

MonthDayYear
Date
Should be Empty: