Retreat Registration Form Registrant Info Name * First Name Last Name Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Phone * (###) ### #### Emergency Contact Name of Emergency Contact * First Name Last Name Emergency Contact Phone * (###) ### #### Emergency Contact Email * Retreat Details Choice of accommodations, payment options, allergies notes, etc. Main Level, with Pool View Please check your option 1 King Bed: $1,550 ($1250 with double occupancy) 1 Queen Bed: $1,550 ($1250 with double occupancy) Lower Level 1 Queen Bed: $1,550 ($1250 with double occupancy) 2 Twin Beds: $1,350 ($1100 with double occupancy) Allergies? Please inform us of any allergies or dietary restrictions in the space below. Payment Options * I accept Venmo or personal check. Please specify your preferred payment method and you will receive pertinent instructions. Venmo Personal check Trip Liability Waiver * Trip location: Avalon, New Jersey 08202 (The private residence of Christine M. Lussier, owner of CYC Yoga). Street address will be provided upon payment. By signing this document, You acknowledge and agree that we, CYC Yoga, Rosa Group, and our partners, are not liable or responsible in any way or manner for any sickness, accidents, losses, injuries, damages, delays, extra expenses incurred, or sustained (whether such losses where foreseen, foreseeable, known otherwise). We, in making arrangements for accommodation, activities, or any service in connection with the trip, shall not be liable for injury, damage, loss, accident, delay or irregularity, liability or expense to person or property, bad weather, and other circumstances. We accept and you agree that we have no responsibility for any pre-existing conditions, sickness, pilferage, labor disputes, machinery breakdown, government restrains, acts of war and/or terrorism, weather conditions, defect in any vehicle of transportation, or for any misadventure or casualty. By checking the box below, you acknowledge and agree to the above terms. I agree to the terms and conditions outlined above Thank you for registering! You’ll receive further instructions shortly.