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SHOSHONI WAIVER

I, The undersigned, hereby confirm and acknowledge that:

1. I have been advised that the Shoshoni Yoga Retreat, 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 its 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 anyand 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 or its staff 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.

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.


First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's 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.
Parent or Guardian's Name

First Name*

Last Name*
Parent or Guardian's 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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