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.
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