1.     I recognize that activities related to yoga, workshops, retreats and/or trips involve physical activities which may be strenuous and may cause injury. I understand that I must judge my own capabilities with respect to any activity. By my participation in any activity or practice taught at or by Willow Vermont Retreat in any location, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, that I may incur.

 2.     I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any activity. I represent and warrant that I am physically and mentally fit and have no medical condition which would prevent my full participation in any activity. I acknowledge that it is my responsibility to inform the instructor of any injury or other condition that might affect my ability to participate in any activities, and to inform the instructor immediately if an injury occurs.

3.     Although I acknowledge there is no obligation for any person to provide medical care during, prior to or after any activity related to Willow Vermont Retreat, I hereby give permission for staff to provide first aid, administer prescribed or OTC medication as prescribed or directed by participant, and/or aid in seeking emergency medical treatment as needed. IN THE EVENT MEDICAL TREATMENT IS PROVIDED TO ME, I HEREBY WAIVE ANY CLAIM AGAINST WILLOW VERMONT RETREAT, LLC, THOMAS CONCANNON, RAVI SHIMPI, THEIR OFFICERS, EMPLOYEES, SUBCONTRACTORS AND/OR AGENTS FOR ANY INJURY, DAMAGES OR DEATH CAUSED BY THE PROVISION OF SUCH MEDICAL CARE.

4.     I, MY HEIRS OR REPRESENTATIVES RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE OR ASSERT CLAIM AGAINST WILLOW VERMONT RETREAT, LLC, THOMAS CONCANNON, RAVI SHIMPI, THEIR OFFICERS, EMPLOYEES, SUBCONTRACTORS AND/OR AGENTS FOR ANY INJURY, DAMAGES OR DEATH AS A RESULT OF PARTICIPATING IN WILLOW VERMONT RETREAT, LLC’S ACTIVITIES OF ANY KIND.

5.     I have carefully read this waiver and release, I understand that I have the opportunity to negotiate its terms with the owners and staff of Willow Vermont Retreat. By signing this form, I voluntarily agree to the above terms.