Wild Vibes Retreat Booking Form: ZION 2019
Thank you for your interest in the Wild Vibes Retreat to Zion! Please fill out this form with the correct and current information below. The more details you can give us, the better! If opting for a private room but with shared bed (couple/friend), each individual person will need to fill out this form.
Email address *
Full Name *
Your answer
Full Address (please include post code + country) *
Your answer
Date of Birth *
How did you find out about the Wild Vibes Zion retreat? *
Your answer
Booking Code (if applicable)
Your answer
Which type of Accommodation do you prefer? *
*Please note* We have limited spaces available for this retreat. Book early to ensure your preference! Selection and pricing is per person.
Traveling with a friend? Please provide the name of the person you would like to room with.
Your answer
Do you have any dietary allergies and/or requests? *
Your answer
Have you been on a retreat before? *
What are you most looking forward to throughout this retreat? *
Your answer
What most interests you and excites you about Zion? *
What is your yoga experience? *
If you have a yoga practice, what type of yoga do you practice?
Your answer
Have you had any experience with meditation? *
How would you best describe your current level of fitness? *
Your answer
Do you have any current or past injuries in your body? If so, please explain. If none, please write 'none'. *
Your answer
Do you have any current or past concerns with your mental health? If so, please explain. If none, please write 'none'. *
Your answer
Emergency Contact Name and Number *
Your answer
Preferred method of payment? *
Please read the Terms + Conditions below. By checking this box you are acknowledging the Terms + Conditions and understand the policies regarding the retreat.
Terms + Conditions
Wild Vibes Retreats are hosted by Wild Vibes LLC.

As a participant of the Wild Vibes Zion Retreat, I agree to the following:

Wild Vibes & its partners, shall not be held liable for any consequences arising from delays or cancellations in any of the companies you may have made travel arrangements with, or for any irregularities in your documentation required for travel.

Wild Vibes & its partners have permission to change the schedule or retreat arrangements at anytime.

Wild Vibes, and its partners, is NOT responsible or otherwise liable for any injuries or illnesses that may incur as a result of any activity associated with the retreat. Likewise, Wild Vibes and its partners is NOT responsible or otherwise liable for any risks associated with the retreat. “Risks” shall include, without limitation, vehicular traffic, road and trail conditions, health conditions, weather, equipment failure, driver error, participant error, food provided, facilities, actions of other people, and the actions, negligence and carelessness of the Released, as defined below. “Released” shall include the Retreat organizers, booking agents, hosts, website hosting partners, retreat hosts, leaders, volunteers, officers, directors, employees, contractors and agents, the owners or operators of any Retreat facilities or equipment provided, and partners of the Retreat.

I hereby certify that there are no health-related reasons or problems that preclude or restrict my participation in the Retreat, that I am physically fit, able to walk on unstable surfaces, such as trails, paths, grass and roads, and have not been advised otherwise by a qualified medical person. I hereby assume all risks of participation in the Activities and the Retreat, including without limitation all Risks, whether such risks are caused (a) by the negligence or carelessness of the retreat leaders, (b) the negligence or carelessness of myself or (c) from dangerous or defective equipment or property owned or provided in any way by the Released. I acknowledge that the Retreat is, or may be an extreme test of my physical and mental limits and carries with it the potential for serious injury, property loss and even death.

I, and on behalf of my executors, administrators, heirs, successors, assigns, and as the parent or legal guardian of a participant of a Retreat, agree NOT TO SUE or make a claim against the Released Parties for any and all damage, death, injuries, loss, or harm that occur during the Retreat or while travel to and from the Retreat and Retreat Activities. This release includes, but is not limited to, claims for strict liability for any abnormally dangerous activities in which I choose to participate in the course of the Retreat, whether caused by negligence or carelessness of the Released or otherwise.

Although I acknowledge that there is no obligation of any person to provide any participant with medical care during, prior to or after a Retreat, in the event medical treatment is provided to me, I hereby consent to such care. Release shall apply to all medical care and such medical care shall be deemed to be an Activity. I acknowledge and agree that I am responsible for my equipment and all personal property during the Retreat and that the Released are not responsible in any way for such property whether it is lost, stolen or damaged. I understand that during a Retreat I may be photographed, videotaped and or my words may be recorded and authorize and allow Wild Vibes LLC and its partners to use such images, words and likenesses for marketing, on websites, in brochures or other writings and any other legitimate purpose.

I agree that the purpose of this agreement is that it shall be an enforceable release of liability and indemnity as broad and inclusive as is permitted by law. I agree that if any portion or provision of this agreement is found to be invalid or unenforceable, then the remainder will continue in full force and effect. I also agree that any invalid provision will be modified or partially enforced to the maximum extent permitted by law to carry out the purpose of the agreement.

I hereby agree to the following: 1. That I am participating in yoga classes offered with WILD VIBES LLC and their instructors, where I will receive information and instruction about yoga. I understand that yoga requires physical exertion which may be strenuous and may be strenuous and may cause physical injury. I am fully aware of the risks involved. 2. I understand that it is my responsibility to consult with a physician prior to and in reference to my participation in yoga classes. I warrant and represent that I am physically fit and have no medical condition that would prevent my full participation in yoga. 3. In consideration of participating in yoga, I agree to assume full responsibility for any risks, injury or damages, which I might incur as a result in participating yoga. 4. I knowingly and voluntarily waive any claim I might have against WILD VIBES LLC and it's instructors, for injury or damages that I may sustain as a result of participating in this program. 5. I, my heirs or legal representative forever release, waive, discharge and covenant not to sue WILD VIBES LLC and its instructors, or any injury or death caused by their negligence or other acts.

Please note:

Students will randomly be placed with one another for same sex shared accommodation. If anyone is traveling with a partner or friend and would like shared accommodation together, please email us as soon as possible to guarantee space.

All guests are responsible for arranging their own flight and transportation to Zion.

Anyone under the age of 18 must be accompanied by an adult who is responsible for the child. Anyone under the age of 18 interested in joining the retreat must first speak to Wild Vibes.

Wild Vibes LLC has permission to change the sample schedule upon arrival. The practices and activities are not mandatory, however Wild Vibes leaders encourage you to join all sessions for your own benefit - to receive maximum results from your retreat experience and to contribute to the groups energy.

Your leaders are trained and experienced professional yoga teachers. They take proper care to ensure all students have a safe and enjoyable experience, however, there is always a chance of injury. In case of an emergency, we will ensure you are taken care of and in good hands of a qualified specialist, however Wild Vibes and its partners cannot be held responsible.

The food and water onsite at Under Canvas Zion is clean and potable. In the case that you fall ill for any reason while onsite, we will do our best to ensure you are taken care of and in good hands of a qualified specialist if need be, however Wild Vibes & its partners cannot be held responsible. The retreat is non-refundable, even if you cannot physically practice.

Wild Vibes & Under Canvas Zion cannot be responsible for any lost or stolen items on site.

Travel arrangements:

All travel arrangements are your responsibility and at you own cost. Wild Vibes shall not be held liable for any consequences arising from delays or cancellations in any of the companies you may have made arrangements with, or for any irregularities in your documentation required for travel.

*** We HIGHLY recommend you purchase travelers insurance to cover any unfortunate situations while traveling. This will also cover any last minute changes if you are unable to join the retreat. ***

Health disclaimer:

We want to share the yoga, fitness, and adventure love with as many people as possible, so our retreats are open to experienced students and beginners alike, with variations/modifications given wherever necessary. Anyone with a reasonable level of fitness will be able to fully enjoy our retreat. If you have had any serious physical or emotional illness within the last 5 years, or are under and medical or psychiatric supervision please advise us at the time of booking. If you are in any doubt about your ability to participate in a yoga and adventure retreat please contact us beforehand to discuss this.

*** We recommend that you extend your health plan to cover you while traveling. ***


Please understand that you are responsible for your own health and well-being during the retreat. Your leaders will instruct you to practice safely and give modifications for any limitations or injuries, however they will not be held liable for any injuries or other medical or emotional problems that may occur, are sustained or aggravated during or after your time on retreat.

Please understand that you participate in the entire program entirely at your own risk and any loss, damage, injury or any other mishap will not be the responsibility of the retreat organizer(s) or teacher(s).

Refunds & Cancellations:

All deposits are non-refundable.

In the event of cancellation by client -

1. 120 days or more prior to the retreat: Your entire payment will be refunded, less your deposit.

2. 61-119 days prior to the retreat: 25% of your entire payment, less your deposit will be refunded, with the option for payment to be transferable (less deposit) to a future retreat of Wild Vibes.

3. 60 days or less prior to the retreat: Payments are not refundable.

For all circumstances listed above, if you are able to find someone to take your place then we can refund you 50% of your deposit.

Transfer must be made to Wild Vibes Bank Account or venmo to @ajgovoni (non-refundable) 50% deposit of your total retreat price is required to reserve your space on the retreat with accommodation onsite at Under Canvas Zion. If you have a bank from outside of the US please include a $15 fee on top of your total retreat price each time you make a transfer.

The final payment is due no later than August 1st, 2019.

This contract must be acknowledged (checked box and submitted) before or by the time of deposit/payment.

Please make a payment either online at www.wildvibes.org/zion-2019 (please note a $15 transaction fee for credit card), to VENMO @ajgovoni or to the following US Bank Account. Payment installments are available for those who need financial support. Please coordinate with Wild Vibes how often the payments are to be made, with the final transfer and full amount paid by August 1st, 2019.

TD Bank
Wild Vibes
Account #: 924 585 6228
Routing #: 011400071

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