Your Name: Company Address City State Zip Code Country E-mail Phone
Emergency Contact: Relation to Applicant: Emergency Contact Phone Number:
Insurance Carrier Policy Number Company Phone Company Address
Arrival Date & Time Airline & Flight Number Departure Date & Time
We recommend that you consult your physician regarding your participation in one of our retreats. Please contact us if you have ANY questions regarding your ability to participate. What is your present state of health? Do you have any pre-existing medical conditions? Do you currently take any medications and if so, which ones? Do you have any pre-existing injuries we should be aware of? Are you pregnant and if so, how many months? Do you have any allergies? Do you have any dietary restrictions?
How long have you been practicing yoga? How many times a week do you practice yoga? Do you have a meditation practice? Do you have a pranayama (breath work) practice?
What most interests you about our retreats? What would you like to get out of this experience? Do you have any experience hiking at elevations above 5,000 ft? If so, when and where? (No experience is required). Do you have any concerns or apprehensions about our retreats? How did you learn about us? Comments
Some, but not all, of the unforeseeable risks you may be exposed to include flash flood, rain, snow, lightning, extreme weather changes, winds, high temperatures, wild animals, venomous reptiles, insects, obscure hazards, downed trees, steep slopes, and terrain lacking water sources. These and other risks and hazards can result in injury, damage, permanent disability, death, or loss.
All participants should wear proper clothing and footwear and carry water for the duration of the outdoor activity, recognizing the responsibility they have to be prepared for a variety of conditions and terrain.