2020 Vision: Create with Clarity and Ease
New Year Retreat Registration Form
Email address *
Full Name: *
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Phone Number: *
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City & State of Residence *
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What is your intention for participating in this retreat? *
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How did you learn about this retreat? *
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Do you have any dietary allergies or restrictions? Please specify, if any. *
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Liability Waiver -- Please read the following and type your name below in agreement, as your electronic signature: You are electing to participate in a yoga retreat, administered by Michelle Chua, of Root 2 Rise Yoga, at Monrovia Canyon Park in Monrovia, CA. This agreement is by and between Michelle Chua, Root 2 Rise Yoga, and the individual whose name is printed below. You, as the participant, hereby agree and understand that it is your responsibility to consult with a physician prior to and regarding your participation in any activities, such as hiking and yoga, associated with the yoga retreat. You represent and warrant that you are over the age of 18 and have no medical condition that would prevent your full participation in the yoga retreat activities. In consideration of being permitted to participate, you agree to assume full responsibility for any risks, injuries or damages, known or unknown, which might incur as a result of participating in the yoga retreat. You, your heirs or legal representatives forever release, waive, discharge indemnify and covenant not to claim or attempt to claim any damages against Michelle Chua or Root 2 Rise Yoga for any injury or death caused by your voluntary participation in the yoga retreat. You have read and understood the above release and waiver of liability and fully understand its contents. You voluntarily agree to the terms and conditions stated above. (Please type your name below.) *
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Cancellation Policy -- Please read the following and type your name below in agreement, as your electronic signature: Your registration investment is non-refundable. In the event that you choose to cancel your participation in this retreat, you may transfer your registration to another registrant approved by Root 2 Rise Yoga prior to the start of the retreat, after providing written notice to Root2RiseYoga@gmail.com via email. (Type your name below in agreement.) *
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Please indicate the payment amount ($65 thru 1/5 or $75 thereafter) and means of payment that you will submit to secure your registration. Payments in US Dollars are accepted via cash, cashier's check, PayPal or credit card, the latter two accruing a 3.5% service charge. Checks can be made payable to "Root 2 Rise Yoga" and mailed to: 3940 Laurel Canyon Blvd. #313 Studio City, CA 91604. Please submit payment only after this registration form has been accepted and space availability is confirmed. *
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Thank you for choosing to join us! After submitting this form, please check your email within the next 1-3 business days for confirmation from Root2RiseYoga@gmail.com.
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