Splendid Mola 1-Day Urban Mini-Retreat Registration Form

Hello!

I am thrilled you can join us. Please take a few minutes and fill out this basic information. If you are attending multiple 1-day retreats, you only have to fill this out once and I will keep the information on file.

Here’s to an excellent word count!

Much love,Lori

Name: Street Address:City, State, & Zip Code:Phone Number: Email: Age:

Emergency Contact

Name:Phone:Relationship:

Food Preference

☐ Vegan ☐ Vegetarian ☐ Omnivore

If you have other food sensitivities, requirements, or requests, please let me know here so I can accommodate them.

Yoga Experience

☐ None/Very little ☐ I know basic poses ☐ Intermediate ☐ Regular practitioner/teacher

General level of physicality

☐ Um…what? I’m a writer ☐ Low ☐ Medium ☐ Fairly athletic

Please list any injuries, health conditions, chronic pain, or issues that I should know about to help customize the yoga classes.

CANCELLATION POLICY

If something comes up and you are not able to attend a 1-Day Retreat for which you have registered, please cancel online no later than 48 hours in advance. If you need to cancel less than 48 hours in advance, please email me directly at splendidmola@gmail.com. If I can cancel your food order I am happy to just transfer your payment to a different retreat. If I cannot, I will issue you an online credit toward another retreat less the cost of food.

WAIVER (REQUIRED)

WAIVER

I, ______________________ [print or type name] am undertaking this Splendid Mola retreat of my own volition and am confident in my ability to participate safely in this retreat. I have read and understand the payments and policies online and agree to abide by them. I understand that all yoga classes are optional and that yoga is a physical practice, in which I am responsible for my own safety. I agree to hold Lori Snyder and Good Life Academy free and harmless from any and all injuries, claims, demands, writers block frustrations, damages, costs, expenses, loss of services, and causes of action resulting from my participation in this retreat. I agree to reimburse Good Life Academy for any property damages resulting from my participation in this retreat. I also give my permission for any photos taken during the retreat to be used to promote Lori’s future retreats, workshops, etc. online or in print. (This is all they will be used for.)

Name: (please print or type) ________________________________ Date: _________________

Signature (If emailing, your name above serves as your signature):_________________________

Please return this form via Email (as an attachment) to splendidmola@gmail.com

Thank you!