The Circle of Womanhood Registration Form for

Wed, June 26 - Sun, June 30, 2019
at the Christine Center in Willard, WI

If you have already submitted your payment please fill our the form below.
For more details refer to the retreat page.  For any questions please email cassie@anandawithin.com

Apply for the payment plan here.

Name *
Name
Address *
Address
Phone *
Phone
Props *
Please bring your own props if you can (we would like you to have 1 mat, 2 blocks, 3-4 blankets, 1 bolster and an eye pillow). If you are not able to please indicate what you are not able to bring and we will aim to have them in place for you.
Vegan, vegetarian, gluten free options are available but please indicate your specific dietary restrictions so we can do our best to accommodate.
If you need to be matched with a room mate please note "find me a room mate". If you already have a room mate you are planning to room with list their name. If you purchased a "single occupancy" accommodation please note in the field "none"
List which housing option you selected.
AMALA SCHOOL OF YOGA Reservation, Cancellation and Release of Liability Agreement 1. Reservation and Cancellation Policy. I understand that my reservation may be transferable to a friend or someone on the waitlist (if applicable) on or before May 31st for a $20 administration fee. I agree to be responsible for finding this participant if there is no waitlist, linking them with Amala, and paying the administrative fee. I understand my reservation may be transferable to a friend or someone on the waitlist (if applicable) on or after June 1st for a $40 administration fee. I will be responsible for finding this participant if there is no waitlist, linking them with Amala and paying the administrative fee. If I cannot find a friend to transfer to, no refunds or credits will be given. In case of a health or family emergency cancellation: Amala will retain a $200 administrative fee and may refund me additionally based on my circumstance and whether I am able to fill my spot. This will be at Amala's discretion and decided within 2 weeks after the end of the retreat. For cancellations on or before May 31st, I understand that I may request a refund of the “Program Package and Room and Meal Package,” less a $200 administrative fee. Cancelling on or after June 1st, or I do not attend, results in no refunds or credits. 2. Release of Liability. I recognize and agree that I must be in good physical and mental health to participate in the Program. I understand that the Program may require intense physical exertion, and I represent and warrant that I am physically fit and I have no medical condition which would prevent my full participation in the Program. I recognize that the Program may cause or aggravate a physical injury or medical condition. I understand that it is my responsibility to consult with a physician before my participation in the Program. If I have done so, I have taken the physician’s advice. I understand that the Program reserves the right to refuse my participation on medical, fitness or any other grounds. I will not hold the Released Party responsible if I suffer from any physical injury or exacerbation of condition while participating in this program. I understand my physical limitations and I am sufficiently self-aware to stop physical activity before I become injured. All of these representations as well as hereafter, apply to any minor children that I may bring. Throughout this Agreement, the term minor children includes an unborn child. In consideration of being permitted to participate in the Program, I agree to assume full responsibility for myself and any minor children I might bring, for any risks, injuries or damages, known or unknown, which I or my minor children might incur as a result of participating in the Program. In further consideration of being permitted to participate in the Program, I knowingly, voluntarily and expressly waive any “Claim” (as defined below) I or my minor children may have against the Amala Yoga School, its owners, managers, teachers, workshop presenters, employees, independent contractors and staff (each, a “Released Party”) for any Claim that I or my minor children may sustain as a result of participating in the Program even if the Claim arises from the negligence of any Released Party or anyone else. I agree to indemnify and hold harmless each Released Party from any loss or liability incurred in defending any Claim made by me or my minor children, or by anyone making a Claim on behalf of me or my minor children, even if the Claim is alleged to or did result from the negligence of any Released Party or anyone else. “Claim” includes but is not limited to any and all liabilities, claims, demands, expenses, fees, legal actions, rights of actions for damages, personal injury, mental suffering and distress, or death that I may suffer, my children may suffer, or that my unborn child may suffer (including any legal fees or expenses) in connection with participation in the Program. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue any Released Party for any Claim caused by any negligence or other acts of a Released Party. I hereby understand that the Program from time to time may photograph or video classes or events occurring at its studios and place such photographs and videos on its Website. I hereby consent to the use of my image that may appear in any such photograph or video. This agreement shall be construed in accordance with, and governed by, the laws of the State of Illinois and that all actions, suits, claims and proceedings relating to this agreement shall be brought in a court of competent jurisdiction located in Chicago, Illinois. In case any provision of this agreement shall be held invalid, illegal or unenforceable, it shall not affect any other provision of this agreement and this agreement shall be construed as if such provision had never been contained herein. 3. Participation and Challenges. During my participation in this Program, I agree to be responsible for monitoring what is safe for me and my minor children, and I agree to stop my participation and that of my minor children in any experience at any time. I will not hold any Released Party responsible for my physical and psychological well-being. 4. Affirmation and verification. In order to make an informed decision about my application to enter the program, I acknowledge that you must be able to rely on the truth and completeness of my submitted information. I acknowledge that I must answer all questions fully and honestly, and have done so. If I am forced to leave the program because of a health consideration, I understand that my opportunity to continue in another session is at the discretion of the Teaching Committee. By signing below, I am affirming that the information provided in this application is true and complete. I acknowledge that providing inaccurate, incomplete, or misleading information is grounds for rejecting this application, or being required to leave the Program after I have commenced participation. I have carefully read the Agreement and the Release of Liability and understand that the Amala School of Yoga/Cassandra Rodgers/Lela Beem, Yoli Maya Yeh, Chanti Tacoronte-Perez, and Uma Dinsmore-Tuli are not responsible for any physical or psychological harm that may result from me or my minor children’s participation in the Program. I hereby verify that I have read this document in its entirety, understand it and agree to all of its terms and conditions. I acknowledge that by signing this agreement, I am giving up substantial rights, including my right to sue and certain legal rights my heirs, next of kin, executors, administrators and assigns may have against any Released Party. I agree to sign this agreement electronically pursuant to the provisions of the U.S. E-SIGN Act.