Name of retreat
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Retreat dates
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Retreat location
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Name
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First Name
Last Name
Email
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Phone
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(###)
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Preferred contact method
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No Preference
Phone
Email
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Date of birth
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Occupation
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Emergency contact name
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First Name
Last Name
Relationship
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Emergency contact phone #
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(###)
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How long have you practiced yoga?
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How often do you currently practice yoga per month?
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What styles of yoga do you practice? Where?
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Do you feel breath awareness is important in your yoga practice?
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Do you practice meditation regularly?
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What other movement and mindfulness practices do you have? How long and how often do you spend doing these practices per week?
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Do you currently teach yoga? If Yes, what styles?
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Do you have any current or past injuries or physical limitations that would be important for us to know as Retreat Leaders?
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Are you taking any prescription medication?
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Any dietary restrictions? (please select which best describes you)
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I eat it all!
I am Vegan - no animal products
I am Vegan - but Honey OK
I am Vegetarian - No eggs or dairy
I am Vegetarian – but dairy is OK
I am Vegetarian - but Eggs & Dairy OK
I am Vegetarian - but Fish & Chicken OK
I am Pescatarian - vegetarian but fish is OK
I am Gluten Free - (i.e. celiac)
I am Gluten Free - but OK to Whole Wheat tortillas or Homemade Granola
Any other specific food allergies?
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At the completion of this Retreat experience what would you like to come away with, and why did you choose this retreat?
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What are your expectations of this retreat? (is learning, relaxing, spending time in solitude, celebrating, two yoga classes a day, all my meals on site, time out and about … etc). Please be specific.
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Do you have any questions for us?
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PLEASE READ AND SIGN
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RELEASE OF LIABILITY: Please complete our QUESTIONNAIRE prior to attending any retreat
1. I am participating in classes or services during which I will receive information and instruction about yoga and health. I recognize that yoga requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved.
2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any physical fitness program, including yoga. I represent and warrant that I have no medical condition that would prevent my participation in physical fitness activities.
3. In consideration if being permitted to participate in the yoga classes, I agree to assume full responsibility for any risks, injuries or damages, known and unknown, which I might incur as a result of participating in the program.
4. In further consideration of being permitted to participate in the yoga classes, I knowingly, voluntarily, and expressly waive any claim I may have against the instructor, the owner, or the leaseholder of the building for injuries or damages that I may sustain as a result of participating in classes or workshops.
5. I hereby grant permission to use my likeness in a photograph, video or other digital media in any and all of its publications, including web-based publications and marketing without payment or other consideration.
I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am digitally signing this agreement voluntarily and recognize that my digital signature serves as complete and unconditional release of all liability of Dana Damara Evolution and staff.
HEALTH PROTOCOL
The following health-safety protocols and procedures are subject to change.
Dana Damara Evolution LLC retreats are offered and facilitated under the primary premise that the overall well-being of all guests is priority.
If prior to arrival, a retreat participant feels ill, has a fever, or has been around someone who has symptoms flu-like symptoms, they are asked to stay home and not travel to the retreat. Travel insurance is highly recommended as the nature of Covid-19 is unpredictable.
While on retreat we ask that everyone takes care of sanitary practices and respect each other’s personal space. At the same time, we want to create a relaxed and enjoyable environment.
We will follow the guidelines for each state and/or county and/or country with regard to COVID protocol
RETREAT CANCELLATION POLICY + COVID-19 TRAVEL RELATED CANCELLATIONS
All retreats are non-refundable once purchased.
For all retreats, if force majeure (e.g. pandemic, natural disasters, travel restrictions, etc.) causes a retreat to be canceled, we will offer a rescheduled date for the retreat. In this case, we will not refund payments when it is due to causes beyond our control. If the rescheduled retreat date does not work for you, you will forfeit your payment and deposits.
If you need to cancel, refunds are not offered unless you find someone to take your spot or we fill the spot. In this case, we may be able to refund you minus any administrative fees incurred in filling your spot.
A minimum $500 processing fee will be accessed for all cancellations of this manner.
We cannot reimburse any travel costs associated with your stay. For this, we recommend travel insurance.
ADDITIONAL INFORMATION
Any credits expire one year after your original arrival date. Refunds or credits will not be given after that time.
There are no refunds or discounts given for arriving late or early departure or for guests who choose not to partake in meals or events..
Dana Damara Evolution is not responsible for any travel expenses related to attending one of our retreats.
TRAVEL INSURANCE
Please consider travel insurance to protect the investment in your vacation plans. Travel (or trip) insurance is available from several companies. We recommend that you carefully review their policies as many provide different levels of protection.
If you find someone to take your spot and they pay in full (transferring your spot), we will refund your money minus any administrative fees. YOU MUST TYPE "I AGREE" in the box below.
Click here to indicate that you have read and agree to the cancellation policy presented below
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E-Signature
First Name
Last Name
Todays Date
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MM
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Thank you for submitting your retreat questionnaire!
If you have any questions regarding our retreat, please email me at dana@danadamara.com.
If you have already paid a deposit, it will be deducted from the full retreat cost. If you know which payment option you’d like to utilize, simply email Dana and let her know what your preferred payment option is. We will speak via phone or email to take your payment, and answer any other questions you may have.
We will be reaching out to you with all retreat details including finalizing payment and other program details. Feel free to email dana@danadamara.com with any questions in the meantime!
We look forward to meeting you, working with you and having you be a part of this very special experience!
All good things,
