Retreat Registration Form
We are so excited you have chosen to travel with us! 
Fill out the form below and you will be sent an invoice for your deposit. 
In the event there is a wait list for the retreat you have chosen, a deposit will not be required until your spot becomes available. 
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Email *
Name (First and Last) *
Retreat Attending:  *
Address *
Phone number *
Birthdate:(must be at least 13 to travel with us. Anyone under 18 must be accompanied by a parent or guardian) *
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Emergency Contact Name (please list someone who is not traveling with you) *
Emergency Contact Phone Number *
Emergency Contact Relationship to You *
Do you have any injuries or limitations that would impact your participation in this trip or in the yoga classes? *
Do you have any dietary restrictions or allergies? *
Have you practiced yoga previous to this trip? *
What styles of yoga do you practice? *
Have you practiced with the retreat leader previously? *
What are your hopes and goals for this retreat? *
Are you attending this retreat with another person? *
If yes, whom?
If yes, would you like to share a room with this person?
Clear selection
List any other relevant information for the retreat leader to know.
Participant Release of Liability

I understand that yoga includes physical movements as well as an opportunity for relaxation, stress re-education and relief of muscular tension. Yoga is not a substitute for medical attention, examination, diagnosis or treatment I understand it is my responsibility to inform the instructor of any limitations before Activity begins. If I experience any pain or discomfort, I will listen to my body, discontinue the activity, and ask for support from the instructor.

I represent and warrant that I am in good physical health and do not suffer from any medical condition which would limit my participation in the Physical Activities offered with instructors through Lucky Elephant Yoga and Wellness, LLC. I also affirm that I alone am responsible to decide whether to participate in activities and at what level of participation is at my own risk.

I understand that this Retreat includes participation in strenuous physical activities including, but not limited to, yoga, walking, jogging, running and possible various programs offered by Lucky Elephant Yoga and Wellness, LLC. I understand the Physical Activities of this retreat may 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 my participation in the Physical Activities. I assume responsibility for all risks associated with the Physical Activities I choose to participate in. I agree to seek competent medical or other professional advice, regarding any concerns or questions involved with the ability to take part in the Physical Activities.

Do you understand and agree?

 *
Travel Release of Liability:

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 Lucky Elephant Yoga and Wellness, LLC and their employees, officers, directors, volunteers and agents (collectively "LEYW") from any and all claims, including claims of LEYW'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 retreat and the activities of this retreat. I am aware of the risks associated with traveling to/from and participating in this retreat, 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 retreat, including travel to, from and during the retreat.

I agree to hold LEYW harmless from all claims, including attorney's fees or damage to my personal property, that may occur as a result of my participation in this retreat, including travel to, from and during the retreat. If LEYW incurs any of these types of expenses, I agree to reimburse LEYW. If I need medical treatment, I agree to be financially responsible for any costs incurred because of such treatment. I am aware and understand that I should carry my own health insurance.

Do you understand and agree?

 *
Limitation of Liability and Full Release of Lucky Elephant Yoga and Wellness, LLC: 

I agree to fully release Lucky Elephant Yoga and Wellness, LLC, 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 I 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 Lucky Elephant Yoga and Wellness, LLC, its owners, employees, any related entities or other authorized agents, including independent contractors. I have been given an opportunity to have this Agreement reviewed by an attorney before signing.

I am 18 years or older or have been approved by a parent or guardian who is traveling with me. I understand the legal consequences of signing this document, including (a) releasing Lucky Elephant Yoga and Wellness, LLC from all liability, (b) promising not to sue Lucky Elephant Yoga and Wellness, LLC, (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.

Do you understand and agree?

 *
Choose your payment method/plan *
Would you like to set up a payment plan?
Payment plans will be set to break down the above chosen payment method based on date of application submission. We will do the math for the monthly breakdown. Payments will be automatically billed on the 15th of each month. 
 *

Refund Policy:

Total payment must be received by date of payment method chosen.
Total refund: Any Cancellation requests must be received in formal writing on or before June 1, 2024.

Cancellations between June 1, 2024 and July 1, 2024: 50% of money paid transferrable to another retreat date. No refunds of any kind given after July 15, 2024.

Do you understand and agree?

 *
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