Poolside Retreat Registration & Waiver

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Thank you for signing up! We look forward to sharing this magical day with you!

After completing this registration form, go back to this page to complete payment. Payment is on a sliding scale. $175 - $215 per person. Each person in your party must complete this form.

Email *

Name *

Phone Number *

Do you have any medical condition that we should know about in case of emergency?

Do you have any food allergies? (We are planning a light vegetarian fare)

How did you learn about this event? *

Direct invite from Karina

Retreats with Karina Facebook Group

Invite from Teresa (Satya Yoga)

Other:

Emergency Contact Number *

Consent & Liability Waiver (please check all boxes to indicate that you have read and agree to the following statements): *

This is a poolside day of activities, I will prepare according to the "What to Bring" list

I am responsible for my own health, including protecting myself from sun exposure

I release the event organizers of any liability in case of injury or illness during this event

I have disclosed any significant medical condition and/or emergency contact information

I have read the cancelation and refund policies and accept these terms

Required

Is there anything else you want us to know? Feel free to comment here. Then return to this page to complete payment. *

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