Tonic Retreats Medical Form2018

 

Please complete this form if you are taking part in a yoga event
with Tonic Retreats.

Name *
Name
This will allow us to identify which event/private retreat you are participating in
Address
Address
Date of birth
Date of birth
Please include country code
Emergency Contact Name *
Emergency Contact Name
Please include country code
Please indicate where you think your ability lies
DIETARY/ALLERGIES PLEASE LET US KNOW IF YOU HAVE ANY DIETARY NEEDS OR SPECIFIC ALLERGIES. PLEASE BE SPECIFIC - IS IT SERIOUS OR A PREFERENCE?
PLEASE INDICATE YOUR GENDER, (USED FOR SHARED ROOMING)
Medical Form
Please tick all that apply and please note all information is treated in the strictest confidence.
Any other information regarding your health or wellbeing that you feel may be of benefit for us to know it advance, examples: problems sleeping, what you would like to gain from your yoga sessions, any physical limitations or past injuries or illnesses.
Terms & Conditions *
ACKNOWLEDGEMENT & WAIVER Release and Waiver of Liability DECLARATION OF HEALTH. By accepting this Participant Agreement I (the event participant) represent that I have no physical conditions or medical precautions which would adversely affect my ability to take part in the yoga activity or other physical activities offered on TONIC RETREATS events. I fully understand that my participation in the yoga or other activities could be injurious to my health and I voluntarily assume all risks related to such activities. PERSONAL RELEASE. By agreeing to the terms outlined here and elsewhere on the TONIC RETREATS website I hereby release and discharge my rights and claims for damages or liabilities that may occur as a result of participation on a TONIC RETREATS event, including but not limited to damages as a result of unexpected occurrences including those from weather, local political situations, wildlife or uncontrollable acts of God, including the risk of death. I release TONIC RETREATS including its owners, directors, employees, guides, yoga teachers and partners from liability for personal injury, illness, emotional damage, incurred travel expenses or property damage I may incur as a result of participation on this trip. For the benefit of everyone at your event, TONIC RETREATS reserves the right to accept or reject any participant at any time without liability, and in the event it determines, in its sole and exclusive discretion, that a participant is disruptive to the harmony of the trip, it may without any obligation to pay a refund or any other amount whatsoever, expel such participant from the event. TONIC RETREATS will carry no responsibility or liability for any participant who leaves the event prior to its conclusion or for any activity undertaken by any participant, which is not included on the event itinerary.