Clone of NOVEMBER Reignite Your Soul Retreat Bali

Nourish & Nurture Esperance Retreat

4-6th September
A $200 deposit must be made to secure your spot in the retreat. Your place on the retreat will only be confirmed once you have made this payment.

Please deposit the funds into the following bank account:

Nadia Fitzpatrick

BSB 063097

Account Number 29813060

Reference: Your name

Once the deposit is paid you will have two options.

1. Set up a payment plan for an additional $50 (this will be added to the payment plan and is to cover the cost of transaction fees)

2. Pay the full amount within 30 days of confirmation of your place in the retreat.
Guest Information
Name*

First NameLast Name
Birthdate

DayMonthYear
Date
Gender
Email *
example@example.com
Phone*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
King Studio Chalet 1 personKing Studio Chalet 2 peopleQueen Room shared en-suit with one other person
Please write the name of the person you are sharing with. They will also need to complete a form.
Emergency Information
Emergency Contact's Name*

Full nameRelationship to you
Phone*
Health Conditions
Do you have any other health limitations or physical injuries?
Do you currently take any medication? Please specify.
Women: Are you pregnant or is there any possibility of being pregnant? If Yes, please indicate your due date

MonthDayYear
Date
Do you have any allergies?
Tell us about you.

Please complete the below questions so that we can accommodate you as best as we can during the retreat.
What inspired you to come to this retreat?*
Have you practiced Yoga before?*
If yes, what type of yoga have you practiced?
Do you have any special dietary requirements? (eg: gluten-free (please specify if you are celiac), allergies (specify if anaphylactic) vegan etc…
Are you ok with being touched or adjusted during a yoga class?*
Are you ok with different scents? (essential oils, almond oil, incense etc.) if no, please provide more detail.
Cancellation Policy

Free cancellation until 18th April.

More than 12 weeks prior to the retreat you will be eligible for a 75% refund. During this time if we fill your spot, we will be happy to provide a full refund (less any fees incurred for those on a payment plan).

Between 12 and 6 weeks you will receive a 50% refund. Full refund (less payment plan fees) if we can still fill your spot.

Less than 6 weeks no refund. You will be able to transfer your spot to someone else. However, this is your responsibility to find a replacement.

Payment policy

If you are on a payment plan and your direct debit fails, Yoga Tribe will try to contact you to update the payment. If there is no response your place in the retreat will automatically be cancelled. Refunds will be in line with our cancellation policy.

If you have opted to pay the remaining balance within 30 days, and you have not paid the balance by the due date and after a reminder, your place in the retreat will be cancelled. Refunds will be in line with our cancellation policy.

Yoga Tribe will make reasonable attempts to send you reminders about your payments, however, it is your responsibility to ensure payments are made on time and that you update any card details you have with us.
AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

I, hereby agree to the following:

1.      That I am participating in the retreat offered by Nadia Fitzpatrick, trading as Yoga Tribe Kalgoorlie, during which I will receive information and instruction about yoga, pilates, meditation, I may be going on walks and swimming. I recognise that these activities require physical exertion that may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.

2.      I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the retreat and any travel precautions. I represent and warrant that I am physically fit and I have no medical conditions that would prevent my full participation in the retreat organised by Nadia Fitzpatrick, trading as Yoga Tribe Kalgoorlie.

3.      I will inform Nadia Fitzpatrick, trading as Yoga Tribe Kalgoorlie, in writing of any health related issues I have that may affect me whilst participating in the retreat.

4.      I understand that if I am pregnant, I will take necessary steps to ensure my doctor and health care providers know I am participating in this retreat. I assert that I am of fit health to participate in the retreat and will alert all teachers whose sessions I participate in that I am pregnant.

5.      In consideration of being permitted to participate in the retreat, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the retreat, including any travel and any or all activities done whilst on the retreat, or as an individual at the accommodation and facilities provided.

6.      In further consideration of being permitted to participate in the retreat, I knowingly, voluntarily and expressly waive any claim I may have against Nadia Fitzpatrick, trading as Yoga Tribe Kalgoorlie and Esperance Chalet Village and staff for injury or damages that I may sustain as a result of participating in the retreat. I, my heirs and legal representatives forever release, waive, discharge and covenant not to sue Nadia Fitzpatrick, trading as Yoga Tribe Kalgoorlie, for any injury or death caused by their negligence or other acts.

If any portion of this release from liability shall be deemed by a court of competent jurisdiction to be invalid, then the remainder of this release from liability shall remain in full force and effect and the offending provision or provisions severed here from. I have carefully read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognise that my signature serves as complete and unconditional release of all liability to the greatest extent allowed by law and that it cannot be changed orally.
Signature*
Date Signed*

MonthDayYear
Date
Should be Empty:

Nourish & Nurture Esperance Retreat

Health Conditions

Tell us about you.