Hi!

I am so excited you’ll be joining me for the upcoming retreat.

Before we start, can you fill out this form below?

Thanks!

Silent Retreat Release

Full Name *

Email *

Please list any physical or medical condition(s) that may limit your participation in physical exercise: *

Please list any medication you are taking and what it is for: *

What is your level of experience with Yoga? *

I certify that the above information is true and complete, to the best of my knowledge. I fully understand that this program/class is educational and that I am solely responsible for my health, safety and wellbeing while participating. I agree to inform my instructor of any activity which I cannot safely perform, and that I will not perform any activity which I feel is likely to cause me to injure myself. I agree to hold the Kristen Manieri, her team and Wish Mindfulness LLC harmless from any and all responsibility for injury which I may sustain during or as a result of my participation in this and all future sessions.

Date *

Signature *

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