Embodied Woman Retreat: Registration Form
Aug 25th-27th, 2023
Bruny Island, Tasmania
Contact us on Ebony: 0429028420 or embodiedlivingtas@gmail.com
Sign in to Google to save your progress. Learn more
Full Name *
Date of birth *
MM
/
DD
/
YYYY
Contact Number *
Email *
Which accommodation option would you like? *
Required
If you are coming with a friend/partner, please write their name below to share a room.
Dietary restrictions *
Are you pregnant, if so how many weeks? *
Have you had any experience with Yoga, Breathwork, Dance or movement practices? If so, please briefly list your experience. *
Do you have any physical injuries/limitations or current illnesses? *
Are you currently taking any medication? *
Is there anything else at all that you'd like to share with us? Any comments or questions are very welcomed.  
COVID-19 safety Declaration: For the safety of all retreat guests we ask that you do not attend this retreat if you present with any cold or flu-like symptoms, unless you have a COVID test, which shows a negative result. Thanks for your cooperation on this :) *
Acknowledgement of Risk:  I understand that during the Embodied Womens retreat I may be participating in forms of Yoga, Breathwork, Dance, Bodywork, Massage, Meditation and other physical and movement classes. Participation in these classes may include, but is not limited to, stretching exercises, possible cardio work, Yoga postures, breathing techniques, swimming and moving in nature. If at any point I feel unsafe, overexerted or fatigued, I will respect my own opinion and body's limitations and I will rest before continuing with any other exercise. By checking the box below, I acknowledge that participation in classes during the Embodied Womens retreat exposes me to a possible risk of personal injury. I am fully aware of this risk and hereby release  Ebony Prins and Abby Gilbert from any and all liability, negligence, or other claims, arising from, or in any way connected, with my participation in the Embodied Womens retreat. I certify that I am physically fit to participate and a licensed medical doctor has verified my physical condition for participation if I have a known medical condition(s). If I am pregnant, or become pregnant, or am post-natal, my acknowledgement and acceptance verifies that I am participating with my doctor's full approval. *
Required
Thankyou for your registration! Please note that your place on retreat is not confirmed until we receive a deposit, or full payment from you. If you'd like to make a direct deposit now, to secure your spot, you can transfer through a deposit of $200, or full payment, with your name as a reference to: Account name: Ebony Prins, BSB: 923100, Acc Number: 67195162                                                                                                                                                                                                                                                  
Cancellation policy: Please be aware that if you need to cancel your spot and have paid a deposit we do not offer refunds on deposits. If you have paid in full and need to cancel, we will refund you 50% of the full fee, if cancellation is made prior to 14 days of the retreat start date. If cancellation is made after 14 days of the retreat start date, no refund is offered. You are also free to transfer your deposit or fully paid ticket to a friend or family member wanting to attend in your place.                                                                                                                                                                                                                                                  
Thankyou so much and we look forward to connecting, sitting in circle and moving with you soon! Big, Wild Love, Ebony & Abby
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Threads Tasmania. Report Abuse