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SHOSHONI WAIVER


I, (Please print name here) ___________________________________________________________ The undersigned, hereby confirm and acknowledge that:

1. I have been advised that the Shoshoni Yoga Retreat, SGRY™ is a non-profit corporation organized under the laws of the State of Colorado, as a spiritual retreat center, whose Retreat and/or Rejuvenation Program involve the utilization of experiential techniques including hatha yoga techniques, meditation practices, and health therapies. I further understand that when I use the facilities of Shoshoni Yoga Retreat, I do so as a member of the ShambhavAnanda Yoga™ spiritual community for the time that I am on the premises and engaged in the activities that are part of its spiritual tradition.

2. I have further been specifically advised that such activation involves some risk of precipitating physical problems related to participant's known or unknown physical vulnerabilities.

3. I have been made aware that, during the course of the above mentioned Retreat or Program, the physiological activation which might emerge during the course of these Retreats or Programs may produce heightened or exceptionally strong physical sensitivity for me during the release of anger, resentment or other deep emotional responses should they occur.

4. I am aware that there might possibly be physical risks and consequences that may be associated with the activities of the Retreats or Programs in which I am willingly participating.

5. I hereby relieve the Shoshoni Yoga Retreat and its assistant(s), agents, and staff of any and all responsibility for any unfavorable outcome in the course of or resulting from these Retreats or Programs which are not the result of the negligence of the Shoshoni Yoga Retreat or the result of any intentional harm inflicted by Shoshoni Yoga Retreat or its agents.

6. I acknowledge that no guarantee or assurance has been made as to the results that may be obtained from my participation in the Retreats or Programs and that my physical body may be subjected to some risk of harm during physiological activation initiated by emotional responses induced by participation in the Retreats or Programs or by participation in the following physical activities of the programs or retreats: 

7. I, the undersigned, having been fully informed by the Shoshoni Yoga Retreat, its staff and/or agents of the hazards and possible consequences involved in the Retreats and Programs set forth above and activities or experiences associated therewith by means of the practices and methods explained to me, nevertheless hereby consent to the use of and my participation in all of the practices and methods associated with these Retreats and Programs. I agree to hold the Shoshoni Yoga Retreat free and harmless for and from any claims, demands, and suits for damages from any personal injury or complications whatever that may result from such Retreats and Programs and I specifically waive any right I may have thereto.

8. I acknowledge that there may be a fee of at least $100 for damage to carpet or furniture. 

9. I, the undersigned, acknowledge that Shoshoni Yoga Retreat reserves the right to refuse service to anyone.

10. I acknowledge and agree to abide by Colorado wildlife guidelines for the safety of Shoshoni guests, residents and staff. By law, individuals are required to stay at least 25 yards (75 feet) away from moose and elk in national parks and 100 yards away from other big game animals. This is required at Shoshoni Yoga Retreat as well. Violations could result in being asked to leave Shoshoni Yoga Retreat and grounds. Thank you for your cooperation. Please read the Colorado wildlife brochure available at the Shoshoni office for further information.

Photo & Media Release Waiver: By signing this waiver, the participant grants S.G.R.Y., Shoshoni Yoga Retreat, and its agents, affiliates, and assigns the right to use, edit, and display any photographs, videos, or other media featuring the participant for promotional, advertising, and other business purposes in any format without requiring further approval or compensation. The participant waives any right to royalties, claims, or ownership interests in the content but may request the removal of their photo by submitting a written request. By signing, the participant acknowledges that they voluntarily enter into this agreement, fully understanding its scope and implications, and release the Released Parties from any claims related to the use of their image.

I certify that I have read and fully understand or have had explained to me the above waiver, and that it is my intention to participate in the above retreat and/or program.


____________________________________________________________________________

Signature of Participant or Person with authority to Consent for Participant                Date


_____________________________________________________________________________

Witness to Signature

First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
Photo's (optional)

I hereby give Faith Stone the absolute right and permission to publish, copyright and use pictures of me in which I may be included in whole or in part, composite or retouched in character or form, in conjunction with (please type initials below): no name to be used

Initial
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name
First Name*
Last Name*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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