2022 Harmonize Retreat

First Name*

Last Name*

Preferred Pronouns*

she/her, he/him/ they/them or any other combination you prefer

Email*

Street Address*

City*

ZIP / Postal*

Country*

Phone Number*

Emergency Contact*

Emergency Contact Relationship*

Emergency Contact Phone Number*

Date of birth

What do you wish to gain from our experience together?*

How many years have you been practicing yoga? Do you consider your level to be Beginner, Intermediate, or Advanced?*

Do you currently have a meditation practice? If so, how frequent?*

Do you have any injuries or conditions that may need medical attention during the training?**

YesNo

If yes, please indicate

Have you attended a training, workshop or retreat with us before? If so, please tell us when and where.

If you are a new student, where did you first hear about EMBODIED FLOW

Please choose one

Vegetarian foodVegan food

If you answered referral or other above, please specify and include full name of your referral*

Please tell us about your previous trainings

Do you have any other movement experience? (eg. dance, martial arts, capoeira)*

How many years have you been practicing yoga?*

What brought you to this particular training?

PERSONAL WELLBEING & MEDICAL DETAILS

Choosing to be part of this training means that you are willing to go deeply into your own process and expansion. It is not intended as psychotherapy, however, it is designed to be challenging and transformative, and we provide support for this. Due to the nature of of the somatic practices we offer in Embodied Flow, sometimes traumatic memories and experiences may surface, which may be triggering or uncomfortable for some participants at some points. We will also be exploring tools for wellbeing, restoration and personal discovery. However please note that this is intended as a training program and not a program for the personal healing of trauma. Whilst the training will certainly provide tools and the opportunity for deep personal transformation and wellbeing, it also requires a level of resiliency and self-responsibility. We do our best to create a safe learning space for trauma survivors, and to educate all participants on trauma-sensitive language and practices. For your own and the group's best interest, we ask you to share openly and honestly about your personal experiences, wellbeing and medical details. Anything you share will remain confidential.

Do you have any current or recurring medical or physical condition that may affect your participation in this training? If so, please indicate the condition thoroughly below*

Are you currently in the care of a medical or natural health care practitioner? If yes, please describe:*

Do you have any other current physical, mental or emotional challenges that could possibly be an issue during the course? (It is important that we are fully informed of such challenges prior to the training). Please be thorough & list in detail.*

Please list previous injuries or surgeries & medical history*

Please list any previous mental health history, including treatment/medication for conditions such as depression, anxiety, panic attacks etc. including any hospitalizations*

Do you have a personal history of trauma experience? (You are not required to provide details here unless you wish to.) What approaches have you taken to work through it, and what is your current relationship to it?*

Anything else you would like to share about yourself before the training?*

REFUND POLICY:

It is the responsibility of each participant to book their flights and transfer and to find out about flight schedule changes relevant to this trip.

Travel Insurance is strongly recommended.

Cancellation refund requests

Cancellation 90+ days - 100% of the rate (minus deposit) will be refunded or 100% credit voucher towards a future event within 24 months of your initial event start date
Cancellation 60+ days - 50% (minus deposit) will be refunded or 100% credit voucher towards a future event within 24 months of your initial event start date
Cancellation within 30+ - 25% (minus deposit) will be refunded or 50% credit voucher towards a future event within 24 months of your initial event start date
Cancellation less than 30 days prior to retreat start - no refund

EVENT CANCELATION:

In the unlikely event that the program is canceled, full payments will be refunded.

Travel expenditures will not be reimbursed, and are considered each individual's own liability.

Liability Waiver:

Tara Judelle offers a variety of yoga retreats and trainings internationally. Some of the programs on this training require physical exertion, which may be strenuous and may cause physical injury. We recommend that you consult your physician before beginning any program. Students must listen to their own bodies and work within their own limitations. If any movements hurt or are uncomfortable; it is your responsibility to never take any exercise to a level of discomfort or pain.

Notice is hereby given that all arrangements made on behalf of participants are made by the organizers on the sole condition that the organizers shall not be held responsible for any injury, death, accident, illness, delay, loss, damage, act of negligence, or irregularity. Tara Judelle acts only in capacity as agent for the participant in all matters connected with hotel accommodations, sight-seeing tours, transportation and other travel expenses, whether by air, rail, bus, motorcar, boat or any other means and as agent holds itself free of responsibility for any damage occasioned by any cause. The undersigned hereby also agrees to indemnify and hold harmless Tara Judelle or any other instructors or facilitators, from and against liability, damages, costs, loss or expense (including without limitation, attorney’s fees) arising out of any bodily injury, illness, or loss at any time sustained by the undersigned.

Talent Release:

I hereby give permission in perpetuity and without fee to Tara Judelle, to use photography and footage in which I may appear in any media or format for Tara Judelle advertising and related promotional purposes. I acknowledge that Tara Judelle owns all rights to the photography and footage. I appear voluntarily and there is no existing restriction or obligation that would prevent me from appearing.

YOUR REGISTRATION IS NOT COMPLETE UNTIL YOU ACKNOWLEDGE THE WAIVER AND CLICK SUBMIT

I have read and understood*

the above refund policy and liability waiver

Please Sign*