Can’t wait to retreat with you!Just need to collect some brief information. Name * First Name Last Name Email * If you reserved a room with a companion(s), please indicate their name(s) below HEALTH INFORMATION Do you have any medical conditions that might affect your full participation in this retreat? * Yes No Do you have any injuries or other physical impairments? * Yes No Do you have any allergies? * Yes No Do you have any specific dietary restrictions? * Yes No What is your coffee/tea milk preference? * EMERGENCY CONTACT INFORMATION Name * First Name Last Name Relationship * Contact's Phone * (###) ### #### Contact's Email * Retreat Agreement * The retreat agreements are intended to create a safe and supportive container for all who attend. Following the agreements demonstrates our commitment to intentional practice in community, with the deep understanding of our interconnectedness during our time together. By signing up for this retreat, each participant agrees to the following: • To attend all practices unless feeling ill. • To maintain silence during the morning practice periods up till lunch. • To refrain from using alcohol or recreational drugs on the day entering the retreat and at any time during the retreat • To refrain from using devices in communal spaces, or in the presence of other participants. I agree LIABILITY AGREEMENT I release Stacie Overby and assistants from all liability which may arise from any and/or all claims by me or any third party in connection with my participation in the retreat. Date * MM DD YYYY Signature * Your typed name here indicates your agreement to this waiver. Thank you!
