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BALI BLISS BLUE JASMIN YOGA RETREAT 2026

Acknowledgement of Risk & Waiver of Liability

Facilitators:

  • Blue Jasmin Acupuncture, Herbs & Yoga Professional Corporation
  • Alexis De Dousis

Retreat Dates:

May 17th–24th, 2026

Location:

Villa Casablanca, Keramas, Bali, Indonesia

Release and Waiver of Liability

In consideration of your participation, you agree to release, waive, discharge, and hold harmless Blue Jasmin Acupuncture, Herbs & Yoga Professional Corporation and Alexis De Dousis (the “Organizers”), and their officers, employees, agents, and representatives from any and all claims, damages, or losses arising from your participation in the retreat, except in cases of gross negligence or willful misconduct. This waiver applies to all activities, including yoga, excursions, travel, and on-site recreational activities.

Assumption of Risk

You acknowledge that participation in this retreat involves inherent risks associated with international travel, yoga and physical movement, excursions, transportation, and time spent in remote areas. You voluntarily assume full responsibility for any risk of injury, illness, accident, death, property loss, or other damages.

Medical Insurance and Emergency Treatment

You confirm that you will obtain personal medical insurance for the duration of the retreat by March 1st 2026. You authorize the Organizers to arrange emergency medical treatment as necessary and agree to be responsible for any associated costs.

Prohibited Behavior

The Organizers reserve the right to remove any participant from the retreat without refund for engaging in violent, disruptive, illegal, or unsafe behavior. Future participation may also be denied at the discretion of the Organizers.

Governing Law

This Waiver shall be governed by the laws of the State of California, and any disputes shall be resolved in accordance with California law.

Arbitration Agreement

Any disputes arising out of or relating to this agreement will be resolved exclusively through binding arbitration in accordance with the rules of the American Arbitration Association in Los Angeles County, California.

Limitation of Liability

In no event shall the aggregate liability of the Organizers exceed the total amount paid by the participant for the retreat.

Indemnification

You agree to indemnify, defend, and hold harmless the Organizers from any and all liabilities, losses, damages, claims, or expenses (including legal fees) incurred by third parties as a result of your actions during the retreat.

Retreat Agreement

1. Reservation and Payment Terms

  • A $600 non-refundable deposit is required to reserve your spot.
  • A second payment of $750 is due December 1, 2025. A $75 late fee applies after this date (unless an alternate payment plan has been arranged).
  • The final balance is due March 1, 2026. A $75 late fee applies if unpaid after this date (unless an alternate payment plan has been arranged). Failure to pay may result in cancellation without refund.

2. Your Obligations

Participants must:

  • Provide accurate personal information, including passport details, health conditions, and emergency contacts.
  • Be in appropriate physical and mental condition to participate.
  • Secure valid passports, visas, submit for arrival card for Indonesia and travel insurance.
  • Submit proof of travel insurance covering trip cancellation, evacuation, and health incidents by March 1, 2026.

3. Organizers’ Obligations

Upon registration confirmation, the Organizers will arrange the following on your behalf:

Included in Your Retreat:

  • Lodging at Villa Casablanca (Single or Double occupancy)
  • Daily Yoga + Meditation
  • One complimentary one hour Balinese massage
  • 7 Breakfasts and 7 Dinners
  • Waterfall Excursion + One additional Excursion (TBD)
  • Pyramids of Chi Sound Healing session
  • Day trips to Ubud and Sanur Beach
  • Airport pickup from Denpasar (DPS) on May 17th 2026
  • Special gifts from your hosts

Not Included:

  • Airfare
  • Lunches, drinks, and snacks
  • Travel insurance (covers trip & health)
  • Gratuities
  • Transport to the airport after the retreat

4. Changes or Cancellations

The Organizers reserve the right to modify or cancel aspects of the retreat if necessary due to weather, instructor illness, or other force majeure events. No refunds will be provided for modifications or changes due to circumstances beyond our control.

5. Cancellations

  • The $600 deposit is non-refundable.
  • Remaining payments are 100% refundable if cancellation is made at least 60 days prior to the start date (Last day to cancel & receive a refund minus non-refundable deposit is March 17, 2026).
  • No refunds are given after this period. No exceptions.
  • Cancellation must be made in writing by email, signed and dated.

6. Publication Release The Retreat Organizer or its representatives may photograph, audio record and/or video record activities that take place during the retreat. The Retreat Organizer reserves the right to publish any such photographs, audio recordings and video recordings without obtaining further consent from any participant. Each participant releases the Retreat Organizer and its representatives from any liability in connection with any such use of such photographs, audio recordings or video recordings.


First Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
First Participant's Date of Birth*
Date of Birth
First Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
First Participant's Signature*
Second Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Second Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
Third Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Third Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
Fourth Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
Fifth Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
Sixth Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
Seventh Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
Eighth Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
Ninth Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
Tenth Participant's Name
First Name*
Middle Name
Last Name*
Phone*
Select Gender
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Emergency Contact's Relation to Participant
Parent or Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
Which room selection would you like to book?
If you chose Double Occupancy, what is the first + last name of who you are sharing the room with?
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Do you have any food allergies/dietary restrictions?
Are there any health conditions/limitations we should be aware of?
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*
Middle Name
Last Name*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
Passport Number *
Passport Country of Issue *
Passport Expiration Date *
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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