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Name
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Date of Birth
Clearly list any dietary restrictions/food allergies you wish for us to accommodate
Policies
Refund policy: You may receive a full refund within 7 days after signing up or by August 1st, whichever comes first. After August 1st, you may receive a 50% refund through September 7th. For event planning purposes, we will honor a $100 refund for last minute cancellations made on or after September 8th, 2018. Drug and Alcohol consumption: The consumption of illegal drugs will not be tolerated over the course of the Freeing Creativity Retreat. You will be respectfully asked to leave if consuming illegal drugs. Alcohol consumption is permitted during dinner time. Alcoholic drinks are not included in the cost of the retreat and will be paid for by the participate. If you consume alcohol, we ask you to drink moderately and responsibly. Stephanie Williams and Brittany Zeller-Holland are not liable for any alcohol related accident or conflict. Waiver, Release, and Assumption of Risk This form is an important legal document. It explains the risks you are assuming by beginning an exercise program. It is critical that you read and understand it completely. After you have done so, please print your name legibly and sign in the spaces provided at the bottom. Waiver, Informed Consent, and Covenant Not to Sue. I have volunteered to participate in a program of physical exercise under the direction of Stephanie Williams, which will include, but may not be limited to yoga postures, physical conditioning exercises, breathing techniques, and meditation. In consideration of Stephanie Williams, agreement to instruct, assist, and train me, I do here and forever release and discharge and hereby hold Stephanie Williams harmless from any and all claims, demands, rights of action, or causes of action, present or future, arising out of or connected with my participation in this or any exercise program including any injuries resulting therefrom. THIS WAIVER AND RELEASE OF LIABILITY INCLUDES, WITHOUT LIMITATION, INJURIES WHICH MAY OCCUR AS A RESULT OF 1) EQUIPMENT THAT MAY MALFUNCTION OR BREAK; 2) ANY SLIP, FALL, DROPPING OF EQUIPMENT OR PROPERTY WITHIN PREMISES; AND 3) AILMENTS DURING/ POST INSTRUCTION. Assumption of Risk. I recognize that exercise might be challenging and that there could be dangers inherent in exercise for some individuals. I acknowledge that the possibility of certain accelerated physical and emotional changes during yoga therapy, yoga, and exercise does exist. I understand that as a result of my participation in herein programs I could suffer an injury. I recognize that an examination by a physician should be obtained prior to involvement in any exercise program. If I have chosen not to obtain a physician’s permission prior to beginning this exercise program with Stephanie Williams, I hereby agree that I am doing so at my own risk. In any event, I acknowledge and agree that I assume the risks associated with any and all activities and/or exercises in which I participate. I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this program. I understand that results are individual and may vary. I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY RIGHT I OR MY SUCCESSORS MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST STEPHANIE WILLIAMS AND/OR BRITTANY ZELLER-HOLLAND.

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