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?*

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

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?*

I. 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
a. 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
b. 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
c. 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
d. Cancellation less than 30 days prior to retreat start - no refund

II. 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.

III. FORCE MAJEURE
Tara Judelle shall not be liable or responsible to the other Party, nor be deemed to have
defaulted under or breached this Agreement, for any failure or delay in fulfilling or
performing any term of this Agreement when and to the extent such failure or delay is
caused by or results from acts beyond the impacted Party’s (“Impacted Party”)
reasonable control, including, without limitation, the following force majeure events
(“Force Majeure Event(s)”) that frustrates the purpose of this Agreement: (a) acts of
God; (b) flood, fire, earthquake or explosion; (c) war, invasion, hostilities (whether war is
declared or not), terrorist threats or acts, riot or other civil unrest; (d) government order
or law; (e) actions, embargoes or blockades in effect on or after the date of this
Agreement; (f) action by any governmental authority; (g) national or regional emergency;
(h) strikes, labor stoppages or slowdowns or other industrial disturbances; (i) epidemic,
pandemic or similar influenza or bacterial infection (which is defined by the United
States Center for Disease Control as virulent human influenza or infection that may
cause global outbreak, or pandemic, or serious illness); (j) emergency state; (k) shortage
of adequate medical supplies and equipment; (l) shortage of power or transportation
facilities; and (m) other similar events beyond the reasonable control of Tara Judelle.
The contract will recommence at the end of such an event and other options for
attendance will be offered.

IV. LIABILITY WAIVER:
a. 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.
b. 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 [a][b] of negligence, or irregularity.
c. 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.
d. 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.
V. 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.

VI. JURISDICTION
a. The parties submit to the exclusive jurisdiction of the courts of Florida,
USA, and any courts that may hear appeals from them in respect of any
proceedings in connection with this contract.

the above refund policy and liability waiver

Please Sign*