THE MANGO WISDOM
RETREAT BOOKING FORM
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CHOOSE YOUR YOGA & AYURVEDA RETREAT *
NAME (AS IN PASSPORT) *
PASSPORT NUMBER *
GENDER
DATE OF BIRTH *
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EMAIL *
WHATSAPP NUMBER *
DO YOU HAVE ANY MEDICAL CONCERNS OR ISSUES INCLUDING MOBILITY ISSUES? *
EMERGENCY CONTACT (NAME & PHONE NUMBER) *
ARE YOU PREGNANT? *
HAVE YOU PRACTICED YOGA BEFORE? *
ARE YOU; *
DO YOU HAVE ANY DIETARY REQUIREMENTS? *
WHAT ARE YOU MOST LOOKING FORWARD TO ON THIS RETREAT?
DO YOU HAVE ANY CONCERNS OR WORRIES THAT YOU WANT TO SHARE?
WAIVER
I understand that Yoga requires and includes physical movements. I realize that Yoga also provides relaxation, stress relief, stress education and awareness. As with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If I experience any pain or discomfort, I will notify the instructor if possible, adjust my posture and listen to my body. I will not push my body too far, I will ask for support from the teacher or stop if needed.
Yoga is not a substitute for medical care or diagnosis. Yoga can work well in conjunction with traditional medical care. I will practice yoga only after discussing it with my doctor and gaining their approval. 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 The Mango Wisdom, Laura Brine and any of The Mango Wisdom Teaching Team.

I, hereby agree to the following:

1. That I am participating in Yoga classes offered with THE MANGO WISDOM, LAURA BRINE, LIEN MEI YOGA & THE MANGO WISDOM TEAM, where I will receive information and instruction about Yoga, Ayurveda & health. I understand that Yoga requires physical exertion which may be strenuous and may be strenuous and may cause physical injury. I understand that Yoga Asana (Yoga postures & exercises) involve postures that stretch, bend & compress every part of the body. I understand that as in the case of any physical activity, risk of injury is always present & cannot be eliminated. I am fully aware of the risks & hazards involved and I take responsibility for my own health. If I experience any pain or discomfort I will listen to my body and discontinue the exercise/activity/ask for support from the teacher. I am fully aware that I am responsible for my own body and my own health. I understand that although I will receive information from The Mango Wisdom, Laura Brine, Lein Mei Yoga & The Mango Wisdom Teaching Team I am ultimately & solely responsible for my own health and the decisions I make regarding my health.
2. I understand that Yoga & Ayurveda are not substitutes for medication attention, examination or treatment. Yoga is not recommended in & not safe in certain medical conditions. I understand it is my responsibility to consult with the physician prior to and regarding my participation in the activities. I represent & warrant that I am physically fit, and that I have no medical condition which would prevent my full participation in the activities offered by The Mango Wisdom & Lien Mei Yoga.
3. I agree to assume full responsibility for any risks, injuries or damages known or unknown which I may incur as a result of participating in the above mentioned activity. I will make the teacher aware of any medical issues via private message before any online PRIVATE or GROUP CLASSES (not applicable in the case of Pre-recorded Video Classes)
4. In consideration of participating in Yoga, I agree to assume full responsibility for any risks, injury or damages, which I might incur as a result in participating Yoga.
5. I knowingly and voluntarily waive any claim I might have against THE MANGO WISDOM, LAURA BRINE, LIEN MEI YOGA & THE MANGO WISDOM TEACHING TEAM for injury or damages that I may sustain as a result of participating in any classes offered by THE MANGO WISDOM.
6. I, my heirs or legal representative forever release, waive, discharge and covenant not to sue THE MANGO WISDOM, LAURA BRINE, LIEN MEI YOGA & THE MANGO WISDOM TEACHING TEAM for any injury or death caused by their negligence or other acts.
7. I have read the above release and waiver of liability and I fully understand its contents. I fully and voluntarily agree to the above terms and conditions.
8. I understand that all materials (including video recordings, hand-outs etc.) provided to me by The Mango Wisdom are for my own personal use and I agree not share them or to misuse them in any way. This includes sharing on social media or any other internet platform and any form of distribution. I agree to respect these precious teachings at all times.
9.    All my personal information will not be shared or sold and will be for the sole use of The Mango Wisdom and Lien Mei Yoga. I give The Mango Wisdom and Lien Mei Yoga permission to use photographs and/or comments in which I may be featured. Photographs and/or testimonials obtained during the course may be shared with participants and/or used as public display which may include The Mango Wisdom or Lien Mei Yoga website, Facebook page, Instagram or other social media, print or electronic publications.
6. I am aware that the retreat fee is not refundable and must be paid in full at the time of booking or according to a pre-arranged payment plan if available.
7. I am aware that no refunds, credits or transfers are available on cancellation prior to, during or after the start date of the retreat due to fixed costs of The Mango Wisdom, venue, teaching team and costs of organisation.
8. The Mango Wisdom reserves the right to terminate any person from the retreat program. I understand that, in the extremely unlikely circumstance that my participation be deemed destructive, inappropriate or unethical, in the sole discretion of The Mango Wisdom, I may be required to leave the retreat before the end date and all amounts paid shall be forfeited. I further understand that all materials, written and created by The Mango Wisdom shall not be copied, reproduced or distributed, in whole or in part, or by any means without written consent of The Mango Wisdom.
9. The Mango Wisdom reserve the right to change the venue in the unlikely event that the group is too large or too small to warrant the hire of the chosen premises, an equal venue with similar facilities will be sought out and provided.
10. In signing this form I am agreeing to behave with consideration & respect to myself, other participants, teachers, organisers & general public.
11. I understand that I am personally responsible for any insurance, visa, passport validity,
12. I have read and fully understand and agree to the above terms of this Liability Waiver Agreement and voluntarily agree to the terms and conditions above as a consideration for participation in the Back to Nature BSL Yoga Retreat in Goa, India offered by The Mango Wisdom. I acknowledge and recognize that my signature serves as a complete and unconditional release of liability to the greatest extent allowed by law.

I have read, understand and agree to the policies above regarding cancelation, payment, release and waiver liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.



BY SUBMITTING THIS FORM I AGREE TO THE ABOVE STATEMENTS *
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