* 1. What is your first + last name? Please also let me know if you prefer being called something different.

* 2. Where are you from?

* 3. What is your date of birth?

* 4. Do you have any previous yoga or meditation experience? If yes, explain.
Do you have any previous trekking, backpacking or hiking experience? If yes, explain.

* 5. Do you have any injuries/surgeries/ health conditions we should know about?

* 6. Do you have any food allergies or special requests? Please specify & don't be shy!

* 7. Please list your emergency contact's name, relationship to you, phone number + email:

* 8. Please tell me your preffered email - this is where I'll send updates and more information.

* 9. Release and Waiver
You acknowledge and agree that:

You understand and acknowledge that the retreat + experiences you sign up to do may be hazardous and may carry the risk of injury or illness, including sickness, physical injury, property damage, disability, permanent paralysis, and death.

TO THE MAXIMUM EXTENT PERMITTED UNDER APPLICABLE LAW, YOU KNOWINGLY, VOLUNTARILY AND FREELY ASSUME ALL RISKS, BOTH KNOWN AND UNKNOWN, OF PARTICIPATING IN EACH ACTIVITY, EVEN IF THOSE RISKS ARISE FROM THE NEGLIGENCE OR CARELESSNESS OF THE HOST OR OTHERS, OR DEFECTS IN THE EQUIPMENT, PREMISES, OR FACILITIES USED DURING THE RETREAT, OR OTHERWISE, AND YOU ASSUME FULL RESPONSIBILITY FOR PARTICIPATION IN THE EXPERIENCE.

You have reasonably assessed the risks involved in the activities and have made an informed and voluntary choice to participate.
You alone, and not your retreat host, are responsible for determining your fitness for participating in the activities and your ability to fully understand any directions or warnings presented.
You will not participate in any activity when you have a physical, medical, or mental limitation or disability, or when you are aware or should reasonably be aware of any factors that may limit or prevent you from safely participating in that activity.
You will act reasonably and responsibly and will comply with any provided and customary conditions, directions, and/or precautions for participation in the activity. If you notice any hazard during an activity, you will stop participating in the activity immediately and alert your retreat host.

By completing this survey, you acknowledge agreement to these terms, and confirm that the above information is true and correct to the best of your knowledge.

Date / Time
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* 10. Upon completion of this survey, you'll receive an email detailing how to place a 50% deposit to secure your space on the trek. I can't wait to meet you! Please let me know if you have any questions or concerns at this time.

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