B_INSPIRED RETREATS APPLICATION

Name *

First

Last

Email *

Please enter your email, so we can follow up with you.

Birthday *

Phone Number *

Address *

City *

State *

Zip *

Emergency Contact Name *

First

Last

Emergency Contact Phone Number *

Do you have a roommate request or are you bringing a friend? *

Name of roommate

First

Last

Food Allergies *

Props

Want to give anyone props for you joining the journey?

Select Retreat *

Waiver and Assumption of Risk Form *

Upon execution this form I, hereby unconditionally release, waive and discharge my right, whether by contract or under operation of law to file cause of action(s) or claim(s) which I may have against Katie Burke DBA Yoga Love Movement, now or in the future. I hereby assume any and all risk of loss, liability, damage or costs, including bodily injury or property damage that may incur arising out or in connection to my acts and/or omissions. I fully understand the terms set forth in this form, and I hereby waive my rights freely and voluntarily without any inducement, assurance, or guarantee being made to me to the fullest extent allowed by law.

Comment