Yoga & Spanish Retreat Form

Name*

First Last

Email*

Enter Email Confirm Email

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nationality

Gender

Date of Birth*

Occupation or Profession:*

Retreat date you are applying for:*

Have you been practicing yoga before? If yes, how long?*

Do you have a meditation practice? If yes, please describe:*

Do you have any injuries, medical conditions or physical disabilities? If yes, please provide details (to be kept confidential):*

Please give a brief description of your overall health:*

Please list anything you think we should know concerning your health conditions, including but not limited to medication, mental health, stress, and any physical limitations.. Be sure to include any dietary restrictions and/or allergies.

What is your level of Spanish?*

Discuss your expectations, goals, etc.

Would you prefer to have Spanish sessions in the morning or in the afternoon?*

Normally the classes are offered either 10:00 - 13:00 or 14:00 - 17:00

What type of accommodation are you interested in?*

Emergency Contact Name*

First Last

Emergency Contact Relation*

Emergency Contact Email*

Enter Email Confirm Email

Emergency Contact Phone*

Emergency Contact Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How did you hear about us?*

I am in good general health and feel physically capable and ready to engage in physical activity. I recognize the potential risk in any physical exercise or work and take full responsibility for determining my own level of participation based on my body’s responses. I knowingly, voluntarily and expressly waive any and all claims I may have against Doron Hanoch or those working with him, for injury, damages or any loss that I may sustain at the Doron Yoga & Zen Center (DYZC), no matter the reason. The information shared by DYZC is not intended as a diagnostic, or as a replacement for any work with a healthcare professional.*

I understand and agree.

The program is structured toward supporting your practice, and extensive consideration has been put into the schedule and methodology. In registering, you commit to do your best to participate according to the program structure and spirit. If you have specific personal needs, please discuss them with the teaching team of DYZC who will do their best to help, but do understand that in the resource-poor context of Guatemala emergency medical response may not be available*

I understand and agree.

Any program may raise personal issues or challenges: welcome this and allow it as part of the process of personal growth and awareness. For these reasons, the experience may be challenging and demanding, and in participating I accept responsibility for my behavior during my stay. I agree to participate in the spirit of a yoga and Zen community and with respect for DYZC, and will be mindful and caring towards the other guests, staff and location. . If at any time, in the sole opinion of DYCZ management, I put myself or others at risk, I may be asked to remove myself from a specific space. In extreme circumstance, in the sole discretion of management, I may be asked to leave. If I am asked to leave due to the DYCZ management determination that I pose a danger to myself or others, I will receive no refund of tuition, room, board or other fees.*

I understand and agree.

I am responsible for my own travel to and from the venue. If travel to the venue is prevented for any reason outside of the control of DYZC, including but not limited to weather, governmental action, and airline cancellation, there will be no refund of tuition, room, board or other fees. I may, after consideration of the circumstances by DYZC, receive credit toward a future event. I agree I will not order a “chargeback” of any credit card payment made for tuition, room, board, or other fees toward the event.*

I understand and agree.

DYZC shall always do its best but is not liable for any failures to perform delivery of this event beyond its control. This covers but it's not limited to: natural disasters, war, ‘acts of God’, epidemics, closure of airports, civil strife, governmental actions, accidents or failure to perform by third parties, and other force majeure events. DYZC accepts no responsibility for delay or cancellation of any flights, buses or other forms of transport. In the event of failure to perform delivery of this program caused by natural disasters, war, ‘acts of God’, epidemics, closure of airports, civil strife, governmental actions, accidents or failure to perform by third parties, and other force majeure events, you may be offered credit toward a future event but you are not entitled to refund of tuition, room, board, or other fees paid. I agree I will not order a “chargeback” of any credit card payment made for tuition, room, board, or other fees toward the event.*

I understand and agree.

DYZC cannot accept responsibility for loss or damage of personal possessions or valuables of the customer; nor can it accept responsibility for any medical conditions and/or circumstances that may arise during the course I am applying for and my stay at the Center. I will organize and have my own adequate medical and travel insurance before I arrive at Doron Yoga & Zen Center. I understand the location of DYZC makes emergency medical access very difficult. In the event of loss or damage of personal possessions or valuable, there will be no refund of tuition, room, board, or any other fees. I agree I will not order a “chargeback” of any credit card payment made for tuition, room, board, or other fees toward the event.*

I understand and agree.

Photography and video may be used for documentation, marketing, and other legal purposes determined by DYZC. I release any claims or rights for any image and grant to DYZC rights to the use of it in any way legal activity. I understand and agree that photographs or videos shared with me by DYZC, or those working with him, are solely for the use of the Doron Yoga & Zen Center and cannot be shared or used in any other way without the express written consent of Doron Hanoch. I solely release any claims for any work I have done for Doron, the DYZC, or any of Doron’s affiliates.*

I understand and agree.

I understand and accept the DYZC Cancellation Policy: • Cancellations with more than a 60 days notice from the start date of the Course will be provided with a total of 50% refund (minus deposit). Cancellations with less than the 60 days notice are non-refundable and I waive all right to payments made for tuition, room board, and any other fees. I agree I will not order a “chargeback” of any credit card payment made for tuition, room, board, or other fees toward the event.*

I understand and agree.

I agree to 20$ per week Service Fee (tips to our kitchen, cleaning, gardening staff)*

I understand and agree.

I understand that my deposit is non-refundable I agree I will not order a “chargeback” of any credit card payment made for tuition, room, board, or other fees toward the event.*

I understand and agree.

I understand that once I am accepted onto the course, I must pay a non-refundable deposit of USD $500 to secure my place.*

I understand and accept that a non-refundable deposit will be required to secure my place in the program and I agree to the terms and conditions of DYZC program to which I'm applying.

By signing below I confirm that I agree to the above terms and conditions.*

SEARCH

Yoga & Spanish Retreat Form

doronyoga