Diamond Forest, Gabriola Island Retreat Registration Form

Diamond Forest, Gabriola Island Retreat Registration Form

Please fill in the form below.
Which retreat(s) are you registering for?

Yoga of Love RetreatDate:____________Personal retreatShakti Rising RetreatOther
Full Name*

PrefixFirst NameLast Name
Address*

Street Address

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CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
Injuries or Conditions
Food Restrictions
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Email
Travel To Gabriola Island
RETREAT COMMITMENTS
1. All retreat participants commit to no alcohol, no drugs, no profanity, no violence, and agree to contribute to an environment of respect for all.
2. All retreat participants agree to maintain mauna (noble silence) from the end of kirtan (8:30pm) until 11am each day.
3. Retreat participants commit to a schedule that starts at 6am and ends at 8:30pm.
4. Retreat participants agree to shared meal preparation and clean up duties. Retreat fees include all meals and your acccommodation.
5. Retreat participants whose snoring may disturb others agree to inform the retreat organizer and to alternative accommodation.
6. Retreat participants understand the rustic nature and isolated environment of this yoga retreat.
7. I understand that this retreat is offered by donation, but that an initial deposit of $108 is required with this registration, and is non-refundable. Balance of retreat fees is by donation.
I have read and understood the retreat commitments.

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WAIVER

As the participant registering for a Diamond Forest Yoga Retreat, I acknowledge and agree with the following:

1. WAIVER OF RIGHT TO SUE.
- I waive any and all claims I may now and in the future have against, and release and forever discharge from all liability, and agree not to sue Yvonne Jaques and visiting teachers for any personal injury, death, property damage or loss (collectively, "Loss") sustained by me as a result of my participation in classes due to any cause whatsoever including without limitation, active or passive negligence, imprudence, lack of skill, error of judgement, breach of contract, or breach of statutory duty of care on the part of Yvonne Jaques and visiting teachers.
- I am in sufficient physical condition to participate in the class and understand that yoga includes physical movements and that the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated.
- Yoga is not a substitute for medical attention, examination, diagnosis or treatment.
- Yoga is not recommended and is not safe under certain medical conditions.
- I affirm that I alone am responsible to decide whether to practice yoga.
I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Yvonne Jaques and visiting teachers.

2. INDEMNITY: I agree to save harmless and indemnify Yvonne Jaques and visiting teachers from and against any and all liability for any Loss to any third party, resulting from my participation in classes or activities.

3. READ AND UNDERSTOOD AND AGE OF MAJORITY: I have read and understood this Waiver and Release of Liability and Indemnity prior to signing it and agree that this instrument will be binding on my and my heirs, executors, administrators and assigns. I am the full age of 19 years.
I have read and understood the waiver.

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Required Deposit
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CAD$108.00 non-refundable deposit required to hold your spot. Balance is by donation - suggested donation is $100 per day.
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