Retreat Participation Agreement and Liability Waiver

Retreat Participation Agreement and Liability Waiver

Harvesting Stillness & Vitality Retreat hosted by Embodied Wisdom Institute LLC The Welcoming Place, Akron, PA | October 29–31, 2026
Welcome & Important Next Steps
Thank you for taking the time to complete this form. It supports preparation, safety awareness, and shared clarity for the retreat experience. This form is best completed on a computer or tablet for readability and ease of signing and may take approximately 15 minutes to complete.

To reserve your retreat participation, all of the following must be completed:
- Complete this Retreat Participation Agreement and Liability Waiver form
- Select your preferred room option & submit your retreat payment
Your retreat participation is confirmed only after all three steps are completed.

Questions about this form or the retreat may be directed to:
Vanessa Simmons at contact@embodiedwisdominstitute.com

Warmly,

The Embodied Wisdom Institute Team
Nature of Service
This retreat provides educational, wellness, contemplative, and experiential programming. Services offered by Embodied Wisdom Institute, its facilitators, staff, contractors, and partners are not psychotherapy, counseling, crisis services, or medical care. Participation does not create a therapeutic or medical provider-patient relationship.

Participants remain responsible for obtaining medical or mental health support outside of this retreat if needed.
Section 1: Participant Information
Name*

First NameLast Name
Pronouns (optional)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Emergency Contact: Full Name*
Emergency Contact Phone Number*
Please enter a valid phone number.
Section 2 — Health, Food, and Sensory Awareness Information
The retreat provides vegetarian meals.

Please share information that supports preparation and awareness:
Dietary Needs and Allergies

Food allergies or medical dietary restrictions:
Food sensitivities or preferences you would like us to be aware of:
Sensory and Environmental Awareness
Please indicate if you experience sensitivity to any of the following. This information supports general awareness only and does not guarantee environmental modification.

Sound or music environmentsVibrational or sound-based experiencesAromatherapy or essential oilsLighting conditionsTemperature variationPhysical proximity within group spacesOther
Participants acknowledge that retreat environments may include natural variations in temperature, lighting, sound, scent, and shared living conditions. Participants agree they are responsible for bringing personal items they may need for comfort or personal management, such as eye masks, sunglasses, earplugs, personal bedding, or similar supports.
Additional Information
Is there anything else you would like facilitators to be aware of to support your participation experience?
Participants understand that while reasonable efforts are made to consider shared participant needs, individualized modifications cannot be guaranteed.
Section 3 — Participation Choice and Self-Pacing
By checking off below, participant affirms:*

I understand participation in retreat activities is voluntary.I agree to engage only in practices that feel appropriate and supportive for my physical, emotional, and psychological well-being.I understand I may pause, modify, or decline participation in any activity at any time.
Section 4 — Health and Illness Policy
To support group well-being and communal safety:*

I agree not to attend the retreat if I am experiencing symptoms of contagious illness, including fever, vomiting, persistent cough, flu-like symptoms, or other transmissible conditions.I understand that if I arrive visibly ill or become ill during the retreat, facilitators may require me to leave the retreat environment for the safety of participants and staff.I understand the cancellation and illness policy outlined in this agreement apply if illness prevents participation.
Section 5 — Assumption of Risk
Participant acknowledges that retreat experiences may include:
- Gentle and moderate movement practices
- Somatic awareness and body-based exercises
- Breathwork and meditative practices
- Vibrational and sound-based experiences
- Emotional reflection and group processing environments
- Outdoor walking or nature-based experiences
- Shared lodging and communal spaces
Participant understands these experiences may involve inherent risks, including but not limited to:
- Muscle strain or physical injury
- Falls or environmental hazards
- Emotional discomfort or activation
- Sensory overwhelm
- Fatigue or physical exertion
- Unpredictable reactions to sound, movement, or contemplative practices
Participant voluntarily accepts full responsibility for monitoring their own well-being and assumes all risks associated with participation.

Participant affirms they are physically and psychologically capable of participating or have chosen to participate with full awareness of potential risks.
Section 6 — Property Care and Community Responsibility
Shared Lodging Acknowledgment

Participants selecting shared room lodging understand they will share sleeping space with another retreat participant.

Participants acknowledge that Embodied Wisdom Institute LLC, its facilitators, staff, The Welcoming Place, and lodging partners:
- Do not screen or match participants based on sleep habits or personal preferences
- Cannot guarantee sleep quality or compatibility between roommates
- Are not responsible for disruptions related to snoring, movement, schedule differences, or other normal shared living experiences
Participants choosing shared lodging accept responsibility for bringing personal comfort items such as earplugs, sleep masks, white noise devices, or similar supports.
Substance and Alcohol Use Policy

Participants acknowledge that the retreat and associated lodging spaces are intended to be safe, supportive, and respectful for all attendees.
- The use, possession, or distribution of illegal drugs or non-prescribed controlled substances is strictly prohibited on retreat premises.
- Alcohol in any form is strictly prohibited on retreat premises, including lodging, common areas, and outdoor spaces.
- Participants must comply with all applicable local, state, and federal laws, as well as property rules.
- Any participant who appears impaired, disruptive, or unsafe to themselves or others may be removed from retreat activities or lodging at the discretion of Embodied Wisdom Institute LLC, its facilitators, staff, and hosting partners, without refund.
Participants are responsible for ensuring they attend in a sober and safe state, and for respecting the shared environment of all retreat participants.
Participant agrees:*

To treat lodging, retreat facilities, and surrounding property respectfully.I understand that if I select shared lodging, I will share a room with another participant, and Embodied Wisdom Institute LLC, its facilitators, staff, and lodging partners are not responsible for sleep quality, roommate compatibility, or shared room conditions.That alcohol, illegal drugs, and non-prescribed controlled substances are strictly prohibited on retreat premises, including lodging, common areas, and outdoor spaces, and that they will attend in a sober and safe state.To leave the retreat space, lodging, and common areas in the condition in which they were found.To accept responsibility for damages caused by intentional or negligent conduct beyond normal use.
Section 7 — Personal Property
Participant acknowledges:*

Embodied Wisdom Institute LLC, its facilitators, staff, volunteers, contractors, The Welcoming Place, and affiliated venues are not responsible for lost, stolen, or damaged personal property.
Section 8 — Media Consent
Participant agrees:*

I consent to photography or video documentation that may be used for educational or promotional purposes
Section 9 — Cancellation and Payment Policy
Retreat registration reserves lodging, meals, staffing, and venue space that cannot be recovered once booked.
- Cancellations made 45 or more days before the retreat start date will receive a full refund minus a $75 administrative fee.
- Cancellations made 30–44 days before the retreat start date will receive a 50% refund.
- Cancellations made less than 30 days before the retreat start date are non-refundable for any reason, including illness, travel disruption, personal emergency, or scheduling conflicts.
Participants agree not to attend the retreat while experiencing symptoms of contagious illness.

Participants are strongly encouraged to purchase travel or event insurance to protect against unexpected cancellations or interruptions.
Electronic Payment and Payment Plan Disclosure

Retreat registration and payment are processed electronically through PayPal.

PayPal may offer payment plan or installment options to some participants. Payment plan availability, eligibility, approval, and terms are determined solely by PayPal and are not controlled, managed, or guaranteed by Embodied Wisdom Institute LLC.

Participants understand that selecting a PayPal payment plan creates a financial agreement directly between the participant and PayPal. Participants remain responsible for completing all payment obligations regardless of retreat attendance, cancellation, or withdrawal, subject to the cancellation policy outlined in this agreement.

Embodied Wisdom Institute LLC is not responsible for PayPal approval decisions, payment plan terms, service fees, or payment processing issues.
Section 10 — Release of Liability
To the fullest extent permitted by Pennsylvania law, participant voluntarily releases, waives, and discharges:
- Embodied Wisdom Institute LLC
- Its owners, facilitators, staff, volunteers, contractors, and agents
- The Welcoming Place
- Any retreat venue partners or property owners
(Collectively referred to as “Released Parties”)

from any and all claims, demands, damages, losses, or liability arising from participation in the retreat, including claims related to physical injury, emotional distress, illness, property damage, or economic loss, except where caused by gross negligence or intentional misconduct.

Participant agrees this release applies to all retreat activities, lodging, meals, transportation between activities, and use of retreat facilities.
Section 11 — Governing Law and Severability
This agreement shall be governed by and interpreted under the laws of the Commonwealth of Pennsylvania.

If any provision of this agreement is found unenforceable, all remaining provisions remain in full force.
Section 12 — Electronic Signature and Acknowledgment
Participant acknowledges:*

I have had sufficient opportunity to read this agreement.Participants acknowledge they have had sufficient opportunity to review this agreement and ask questions before signing.I understand I may seek independent legal or professional advice before signing.I understand that checking boxes and signing electronically constitutes my legally binding signature under federal ESIGN and Pennsylvania UETA law.I am signing voluntarily.
Signature*

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Date*

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Retreat Participation Agreement and Liability Waiver

Welcome & Important Next Steps

Nature of Service

Section 1: Participant Information

Section 2 — Health, Food, and Sensory Awareness Information

Dietary Needs and Allergies

Sensory and Environmental Awareness

Additional Information

Section 3 — Participation Choice and Self-Pacing

Section 4 — Health and Illness Policy

Section 5 — Assumption of Risk

Section 6 — Property Care and Community Responsibility

Shared Lodging Acknowledgment

Substance and Alcohol Use Policy

Section 7 — Personal Property

Section 8 — Media Consent

Section 9 — Cancellation and Payment Policy

Electronic Payment and Payment Plan Disclosure

Section 10 — Release of Liability

Section 11 — Governing Law and Severability

Section 12 — Electronic Signature and Acknowledgment