Name *
Full Payment was made at time of registration *
Do you have any dietary restrictions? *
Have you practiced Kundalini Yoga before? *
1. That I am participating in the Yoga Retreat offered by Genevieve Cipes during which I will receive information and instruction about yoga and meditation. I recognize that yoga requires physical exertion that may be strenuous and could cause physical injury that I am fully aware of the risks involved. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the yoga classes and workshops. I represent and warrant that I am physically fit and I have no medical condition that would prevent my participation in the yoga retreat classes. 3. In consideration of being permitted to participate in the yoga retreat, I knowingly agree to assume full responsibility for any risks, injuries, or damages, known or unknown, which I might incur as a result of participating in the program. 4. By signing this release, I agree that Genevieve Cipes, Ratna Ling Retreat Center, their volunteers and employees, representatives, agents are all hereby released from liability for any and all claims, obligations, damages, losses, injuries, and/or causes of action arising as a result of participation in the yoga retreat. 5. I, my heirs or legal representatives, forever release, waive and discharge and covenant negligence or other acts. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above. By signing this release, I further agree and understand that nobody has made any warranties about the safety and protection of myself and my possessions during participation. By signing the release, I voluntarily take part in the Yoga Class/Retreat at my own risk. When this form is made available online and signed electronically, the electronic signature will be considered the same as an ink signature.