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B_INSPIRED RETREATS APPLICATION

Name *

Date of birth *

Phone *

Email *

Current Address *

City *

State *

Zip code *

Are you bringing friends/roomate request? *

Yes

Name Of Roommate *

Emergency Contact Name *

Name of a relative not residing with you

Address *

Phone *

City *

State *

Zip Code *

Relationship *

Nightly Habits

Night Owl

Early Riser

Deep

Light Sleeper

Co-ed Rooming ok

Share a queen with another of same sex

Food Allergies *

Please list any allergies to tell the chef and allergies to smells..

Props *

Want to give anyone props for you joining the journey?

Select from the list *

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.

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