Yoga Recovery Pittsburgh Retreat Participant Form
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Full Name *
Date of Birth
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Email Address *
This will only be available to the Retreat Leader and never be shared
Phone Number *
This will only be available to the Retreat Leader and never be shared
How long have you been in recovery?
We recommend being in a harm-reduction or abstinence routine for at least 3 months prior to attending the retreat
What is your substance or behavior of choice?
Do you have any physical limitations, visual, or auditory impairments that would prevent you from participating in a yoga practice or meditation?
This is only for the purpose of making our curriculum accessible to as many individuals as possible. Your invitation is not impacted by anything you include in this response.
Do you have any special requests, including dietary restrictions, that would help improve your experience? *
Vegetarian and vegan options are a given, though please provide any other accommodations you may need to have the best weekend possible
Any other information the Group Leader should know?
All program content is applicable to all in any stage of recovery. It is recommended you be without substance use for 3 months or longer before joining a retreat group. If there are any concerns, we welcome you to provide information below! We welcome ALL to participate.
Confirm your retreat payment has been received
PayPal payments are available via this link: https://www.paypal.com/paypalme/YogaRecoverypgh

Please note our refund and cancellation policies:
A $100 non-refundable deposit is required to reserve space. Your retreat balance is due in full minimum of 1 week prior to event start date. Most retreats will range between $200-$300 per person depending on the venue, and all venues will be within a 1-2 hour drive from Pittsburgh City. Cancellations will be honored with refund minus deposit up to 3 weeks before event start date. After this time, tuition is non-refundable but transferable to a future retreat. Visit the Events page to get registered and check out more upcoming events!
Waiver of Liability *
In checking the box below I agree that I am or will be participating in the Yoga Classes, Health Programs or Workshops offered by Yoga Recovery Pittsburgh during which I will receive information and instruction about yoga and health. These classes may entail physical activity and exertion by me. I recognize that such physical activity and exertion may be difficult and strenuous and may cause or aggravate a physical injury or medical condition. I am fully aware of and accept the risks and hazards involved. I understand that it is my responsibility to consult with a physician prior to and regarding my participating in the Yoga Classes, Health Program or Workshops, and to receive prior approval to participate. I represent and warrant that I am physically fit and I have no medical condition or injury which would prevent my full participation in the Yoga Classes, Health Programs and Workshops. In consideration of being permitted to participate in the Yoga Classes, Health Programs or Workshops, I agree to assume all full responsibility for any risks, conditions, injuries or damages, known or unknown, which I might incur or aggravate as a result of my participating in same. In further consideration of being permitted to participate in the Yoga Classes, Health Programs or Workshops (the “Programs”), I knowingly, voluntarily and expressly waive any claim I may have or acquire against Yoga Recovery Pittsburgh, or the landlord or any premises at which it may operate, for any injury, condition or damages that I may sustain as a result of entering or being on the premises or participating in the Programs. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue Yoga Recovery Pittsburgh, or the Landlord of any premises at which it may operate, for any injury, condition, or death which arises, is caused by or is aggravated by reason of my participation in the Programs. I understand that it is my continuing responsibility to inform the instructor(s) at Yoga Recovery Pittsburgh of any previous medical conditions, injuries or surgeries prior to my first class and at such other times as I acquire information as to same. Any service fees paid or donations contributed hereafter are non-refundable. I understand that Yoga Recovery Pittsburgh or any premises at which it may operate are not responsible for any lost or stolen personal, or otherwise, items that I own and bring to the studio. I knowingly, voluntarily and expressly waive any claim I may have or acquire against Yoga Recovery Pittsburgh, or the landlord or any premises at which it may operate, for any lost, stolen, or broken personal, or otherwise, items. I also understand that, except for a monetary refund, I have no claims against Yoga Recovery Pittsburgh, or the landlord of the premises, by reason of their refusal to allow me to participate in the Programs.
必須
Date of Registration *
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