Name
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First Name
Last Name
Email
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Phone Number
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(###)
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Payment Option
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Check (payable to Jessica Chin)
Venmo
Zelle
PayPal
Date of Birth
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MM
DD
YYYY
Home Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Emergency Contact Name
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Emergency Contact Number
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(###)
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How long have you practiced yoga? How often do you practice yoga? Who/where do you practice yoga with?
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What comes easiest to you in your yoga practice? What has been the most challenging in your yoga practice? What is something you want to explore more of in your practice?
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Are you interested in meditation and breathwork practice?
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Are you interested in Pilates, Cardio Challenge, Dance, Restorative, etc at the retreat? (List any other modality you enjoy or may like to have on retreat.)
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Do you have any injuries? Or medical conditions that we need to be aware of? If so, what are they?
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Do you have any food allergies? Or any dietary restrictions? If so, what are they?
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What is something you hope to do in Mallorca? (i.e. sights, expectations, etc.)
Any other comments/messages for Jessica & Michael?
NON-REFUNDABLE + NON-TRANSFERABLE DEPOSIT
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Yes, I understand a $800 deposit is required to secure my spot on this retreat and is non-refundable and non-transferable. All final payments must pay in full by April 28, 2025.
ASSUMPTION OF RISK, HEALTH WARRANTY, RELEASE & WAIVER OF LIABILITY
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RELEASE AND WAIVER OF LIABILITY
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In consideration for my participation in "Mallorca Yoga & Fitness Retreat 2025" with Jessica Chin & Michael J. Clark, I, individually, and on behalf of my relatives, legal representatives, and assigns, agree not to sue and hereby agree to defend, indemnify, release and hold harmless to the facility where I am doing my retreat and Jessica Chin & Michael J. Clark ("JC&MJC") and each of their respective shareholders, owners, officers, directors, members, employees, contractors and agents, and the owner of the Balearic Retreats (the “Facilities”) where the Retreat occurs (collectively, the “Releasees”) from all actions, claims, demands, suits, losses, liabilities, charges, expenses (including, without limitation, attorneys’ fees), and costs of any nature whatsoever which may arise out of, relate to, or result from, any injury, economic loss or any damage to me or my guest or relatives resulting from my participation in physical exercise and yoga, Pilates, cardio, dance, and fitness instructional classes at the Facilities, entry to or use of the equipment, facilities or services at the Facilities, the negligence of the facility where I am doing my retreat or Jessica Chin & Michael J. Clark, anyone at the facility where I am doing my retreat or Jessica Chin's & Michael J. Clark’s behalf or anyone using the Facilities or JC&MJC’s equipment, facilities or services, except such as may arise out of the gross negligence or willful misconduct of the Releasees. This release and waiver of liability (this “Release”) is intended to be a complete release of any responsibility for personal injuries and/or property loss/damage sustained by me while at the Facilities, whether using exercise equipment, participating in active or passive exercise, or not. I understand that this Release is intended to be as broad and inclusive as it permitted by the laws and jurisdiction applicable to the facility where I am taking my training and that if any portion of this Release is held invalid, I agree that the balance of this Release should continue in full force and effect.
