HEAVEN ON EARTH BALI RETREAT 2018
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Call us at 1-416-696-0086
of Retreat: RETREAT 2018
Name of Retreat:HEAVEN ON EARTH BALI
Phone# Home__________________ Wk__________________ e-mail_______________________________
Cell phone __________________________Your occupation_________________________________________
PLEASE CHECK YOUR CHOICE
_____ INDIVIDUAL package rate
_____ GROUP OF _______ package rate. Please name members of your group. _______________
CHECK YOUR CHOICE & FILL IN CURRENT WEBSITE WORKSHOP FEE
#2 ____$__________ I AM SO WORTH IT PACKAGE includes Heaven on Earth Workshop PLUS:
#3 ____$__________ I AM SO FABULOUS PACKAGE includes Heaven on Earth Workshop
are in the
currency of your resident country.
Emergency Contact: Name_____________________________________________________________
Phone: day_________________________ evening ______________________cell_____________________
Three things that I am looking forward to on this retreat:
I have a travel partner I would like to share accommodations with: Yes_____ No______
travel companion will also be participating on the retreat:
My travel companion will also be participating on the retreat:Yes_____ No______
Booking and Cancellation Procedures
retreats are filled on first to pay basis.
Please reserve your room and make note of any food considerations
with the travel agent found on the web page www.aziza.ca/bali.htm
Please reserve your room and make note of any food considerations with the travel agent found on the web page www.aziza.ca/bali.htm
I understand it is my responsibility to be informed of
resort cancellation policy.
I understand it is my responsibility to be informed of resort cancellation policy.
If the 2018 Bali Retreat is cancelled by Aziza Healing Adventures you will receive a FULL REFUND for workshop fees. (Less cost for pants if included in your package and already worn)
In the unfortunate instance that you cancel your registration, please do so in writing. Your retreat fee for FOUR group workshops in Bali will be credited towards 7 hours private self-discovery sessions by phone or skype with Laila Ghattas. Please complete these sessions within six months of your written cancellation notice. If you have chosen package #1 or #2 that include private sessions, this credit will be in addition to those package hours.
Retreat Workshop Fees are NON REFUNDABLE without exception__________ (initial)
Please note your are solely responsible for all non refundable and non transferable travel arrangements and do so at your own risk. __________ (initial)
I have discussed any concerns with the above cancellation policy
and retreat questions during the 15 min. pre registration interview.
I have discussed any concerns with the above cancellation policy and retreat questions during the 15 min. pre registration interview.________ (initial)
I understand and accept Aziza Healing Adventures Retreat Booking and Cancellation conditions.
Health Insurance Company contact number_____________________________________________
This information can be provided when purchased. Please pack
a copy of your medical travel insurance policy.
Please pack a copy of your medical travel insurance policy.
Please evaluate your health- emotional and physical: Fair_____ Good______ excellent______
Please evaluate your fitness: Fair______ Good_____________ excellent_______________
List any physical or medical limitations that might affect your participation on this retreat:
List any allergies that might affect you on this retreat:_______________________________________________
Have you informed the resort of any dietary restrictions? Yes________ No_______
To my knowledge I am fit and emotionally capable of undertaking the retreat outlined in the AHA web site information.
Waiver of All Claims, Release from Liability And Assumption of Risks Agreement.
To: Aziza Healing Adventures (AHA)
In consideration of AHA accepting my application for participation in the personal growth retreat from
_____________to_____________, year___________, I agree to this release of claims, waiver of liability and assumption of risks. On behalf of myself, my heirs, executors, successors, administers and assigns and any other person who may have an interest at common law or by operation of statute, I hereby waive any and all claims I or such parties may have now or in the future, and release from liability AHA, its founder, directors, officers, employees, guides, agents or representatives (" the releasees") for any personal injury, death, property damage or loss or any nature suffered by me as a result in participation in any activity on the retreat with AHA due to any cause whatsoever including those arising out of, or in any way connected to or occasioned by the negligence of the releasees. _________ (initial)
I am aware that personal growth activities are designed to promote emotional awareness and I accept responsibility for my emotional health during and after the retreat. I acknowledge the enjoyment and challenge I receive from emotional risks involved in participating in personal growth activities on personal growth retreats. _________ (initial)
am aware that unless I'm otherwise notified of a retreat cancellation,
this retreat WILL PROCEED, and that the registration cancellation
policy is in effect and applies REGARDLESS OF ANY POLITICAL OR WEATHER
RELATED EVENTS or other unforeseen events taking place prior to the
start or during the retreat dates.
I am aware that unless I'm otherwise notified of a retreat cancellation, this retreat WILL PROCEED, and that the registration cancellation policy is in effect and applies REGARDLESS OF ANY POLITICAL OR WEATHER RELATED EVENTS or other unforeseen events taking place prior to the start or during the retreat dates.
I am aware that Aziza Healing Adventures and its operator is not responsible for the quality of service, meals, spa treatments, amenities, classes, yoga, tours, activities, transfers and room, and anything else supplied or arranged by the travel agent and resort. _________ (initial)
I understand Aziza Healing Adventures and its operator is responsible only for facilitating the Heaven on Earth Bali Retreat workshops as outlined on the web pages. I understand it is for this workshop facilitation I am paying the above fees.
1. Terrain- Natural areas and waters are subject to natural forces which result in obstacles and hazards.
2. Isolation- Retreats are in remote and natural areas, and rescue and medical treatment may not be available for several hours.
3. Animals- Hiking, swimming, boating in natural areas may result in encounters with wild animals and insects which may injure, damage or capsize.
4. Weather- Weather may change rapidly and may be extreme, presenting significant challenges.
I acknowledge the enjoyment and challenge I receive from natural outdoor experience, its isolation and the opportunity to experience nature in a natural surrounding and state, and emotional experiences resulting from personal growth exploration. This is my reason for participating in this retreat, and I voluntarily assume all risks associated with these activities and freely waive any and all legal rights that I may have against the releasees.
I am medically, physically, emotionally and in all respects fit and able to participate in personal growth adventure travel. I have no medical requirement or condition except what is outlined in the Registration/Medical form.
I agree I will be fully and financially responsible for my own physical condition and well being during the retreat and will follow the safety precautions and instructions prescribed by AHA and its hired operators.
In the unfortunate event that I choose to engage in legal matters with Aziza Healing Adventures and/or its founder, directors, officers, employees, guides, agents or representatives, I accept the terms that all legalities will in totality be processed and proceed in Toronto, Ontario, Canada.
I have read carefully and understand this agreement.
describing this event, itinerary
and fee package inclusions and exclusions for which I'm registering.
describing this event, itinerary and fee package inclusions and exclusions for which I'm registering.
printed name___________________________________________________ _______________
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Aziza Healing Adventures
e-mail: firstname.lastname@example.org , Phone: 1.416 .696.0086