Winter Retreat Registration (February 2022)
I look forward to creating space for you at the Mid-Winter Wellness Retreat. Please answer the following questions below to register for the 1 day retreat. Payment information will be sent within 24 hours following submission of this form. The retreat is being held on Private Property approximately 40min north of Grand Rapids, MI, a few miles off 131. Exact location & directions will be communicated in email prior to the retreat.

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I am interested in registering for (select all that apply) *
Required
Name (first & last) *
Phone Number *
Home Address *
Email Address *
Date of Birth *
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Name of Emergency Contact (first & last name) & Relation to you *
Emergency Contact Phone Number *
Any special Dietary, Mobility or Medical needs/restrictions? *
What do you hope to gain from this retreat?
Why is Rest important to you?
When was the last time in your life you felt rested, replenished or restored?
Please use this area to ask or voice any concerns relative to your participation in any wellness retreat activities (hiking, mobility work, meals, workshops, etc)
Waiver Agreement: RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS.
 In consideration for being allowed to participate in this Activity, on behalf of myself and my next of kin, heirs and representatives, I release from all liability and promise not to sue Muir Wellness and their employees, officers, directors, volunteers and agents (collectively “MW”) from any and all claims, including claims of MW's negligence, resulting in any physical or psychological injury (including paralysis and death), illness, damages, or economic or emotional loss I may suffer because of my participation in this Activity, including travel to, from and during the Activity. I am voluntarily participating in this Activity. I am aware of the risks associated with traveling to/from and participating in this Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and/or death. I understand that these injuries or outcomes may arise from my own or other’s actions, inaction, or negligence; conditions related to travel; or the condition of the Activity location(s). Nonetheless, I assume all related risks, both known or unknown to me, of my participation in this Activity, including travel to, from and during the Activity. I agree to hold MW harmless from any and all claims, including attorney’s fees or damage to my personal property, that may occur as a result of my participation in this Activity, including travel to, from and during the Activity. If MW incurs any of these types of expenses, I agree to reimburse MW. If I need medical treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. Participant Release of Liability PC’s Acknowledgement and Assumption of Risk: PC acknowledges that the Services provided by Muir Wellness, hereunder include participation in strenuous physical activities, including, but not limited to, yoga, weight training, walking, jogging, running and possible various nutritional programs offered by Muir Wellness. PC acknowledges these Physical Activities involve the inherent risk of physical injuries or other damages, including, but not limited to, heart attacks, muscle strains, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness, or injury however caused, occurring during or after PC’s participation in the Physical Activities. PC further acknowledges that such risks include, but are not limited to, injuries caused by the negligence of an instructor or other person, defective or improperly used equipment, over-exertion of PC, slip and fall by PC, or an unknown health problem of PC. PC agrees to assume all risk and responsibility involved with PC’s participation in the Physical Activities. PC affirms that PC is in good physical condition and does not suffer from any disability that would prevent or limit participation in the Physical Activities. PC acknowledges participation will be physically and mentally challenging, and PC agrees that it is the responsibility of the PC to seek competent medical or other professional advice, regarding any concerns or questions involved with the ability of the PC to take part in the Physical Activities. PC agrees to assume all risk and responsibility PC’s exceeding his or her physical limits. Client further acknowledges that he/she is not relying on Muir Wellness's expertise and expressly waives and warranties of merchantability, fitness for a particular purpose, fitness of ordinary use, qualifications of Muir Wellness, the availability, quality of the facilities or service of Muir Wellness, the results obtained through exercise, diet, weight control, or physical fitness conditioning programs or any other implied or express warranty to the fullest extent permissible by law. Limitation of Liability and Full Release of Muir Wellness: PC, his or her heirs, assigns and next of kin, agree to fully release Muir Wellness, its owners, employees, any related entities or other authorized agents, including independent contractors from any and all liability, claims and/or litigation or other actions that PC may have for injuries, disability or death or other damages of any kind, including but not limited to, direct, special, incidental, indirect, punitive or consequential damages, whether arising in tort, contract, breach of warranty or arising out of participation in the Services, including, but not limited to the Physical Activities, even if caused by the negligence or fault of Muir Wellness, its owners, employees, any related entities or other authorized agents, including independent contractors. PC is urged to have this Agreement reviewed by an attorney before signing.I am 18 years or older. I understand the legal consequences of signing this document, including (a) releasing MW from all liability, (b) promising not to sue MW, (c) and assuming all risks of participating in this Activity, including travel to, from and during the Activity. I understand that this document is written to be as broad and inclusive as legally permitted. I agree that if any portion is held invalid or unenforceable, I will continue to be bound by the remaining terms. I have read this document, and I am signing it freely. No other representations concerning the legal effect of this document have been made to me. *
Payment is due 7 days in advance of the retreat. (Feb 19th) Cancellations must be confirmed in writing (email leah@muirwellness.com) and refunds are allowed up to 8 days before retreat. All monies paid are transferable up to 48 hours prior to retreat start and must be confirmed by Muir Wellness. Do you understand and agree to the payment and cancellation policy? (direct link to pay will be sent via email within 24 hours after submitting this registration form) *
Muir Wellness is committed to working alongside groups & individuals to make a safe experience for you during your retreat. Individuals who are sick themselves or display any symptoms (including, but not limited to: runny nose, fever, body aches, sore throat, cough, diarrhea, vomiting) have illness in their household, or have recently been exposed (within 7 days prior to retreat date) to COVID-19 should stay home. We will offer a credit with MuirWellness if the cancellation due to illness/exposure is after the cancellation deadline. Participants must contact Muir Wellness directly prior to the event (leah@muirwellness.com) to cancel. Participants are highly encouraged to be fully vaccinated and boosted. *
Are you willing to have your photograph taken for future marketing or promotional materials associated with Muir Wellness? *
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