Peru Yoga Retreat August 31st - September 8th, 2024 Consent Form In consideration for being allowed to attend and participate in this Peru Yoga Retreat, I will not hold Yogimemes llc, Pedro Luna, Sumer Luna, Synergy Yoga, Francisco Morales Bermudez, or Salim Rollins, liable for the possibility of contracting COVID-19. I understand the COVID-19 virus has a long incubation period during which carriers of the virus may not show symptoms and still be highly contagious. It is impossible to determine who has it and who does not. I understand that due to the other attendees, the characteristics of the virus, and the characteristics of the yoga retreat, that there is an elevated risk of contracting the virus simply by being on the retreat, I confirm that I will not arrive to the retreat beginning August 31st, 2024, and be presenting with any of the following symptoms of COVID-19 included but not limited to the following list. ● Fever ● Shortness of breath ● Loss of sense of taste or smell ● Dry cough ● Runny nose ● Sore throat ● Red eyes ● Rash ● Abdominal pain ● Vomiting ● Diarrhea To prevent the spread of contagious viruses and to help protect each other, I understand that I have read the above Peru Yoga Retreat COVID-19 protocols and agree to these guidelines. I also understand and agree that, if I observe, become aware of, or in any way have or gain knowledge of any unusual or significant hazard during my presence or participation, including but not limited to the presence of any communicable disease, I will remove myself from participation and bring such to the attention of the instructor or staff immediately. Waiver and Release from liability from Yogimemes llc, Pedro Luna, Sumer Luna, Synergy Yoga, Francisco Morales Bermudez, or Salim Rollins. I have chosen to attend this retreat and understand that all activities are voluntary. I acknowledge that I understand the nature of the activities I will be participating in and the possibility that despite precautions, accidents and/or physical injury may occur. I agree to release and hold harmless Yogimemes llc, Pedro Luna, Sumer Luna, Synergy Yoga, Francisco Morales Bermudez, or Salim Rollins, from any cause of action, claims, or demands now and in the future. I will not hold liable Yogimemes llc, Pedro Luna, Sumer Luna, Synergy Yoga, Francisco Morales Bermudez, or Salim Rollins, for any personal injury or any personal property damage or loss, which may occur on the premises before, during or after the retreat or at any sponsored event outside the retreat. Furthermore I agree to take full responsibility for my/our behavior in addition to any damage I/we may cause to Willka T'ika Essential Wellness. By selecting I agree below this is proof of my intention to execute a complete and unconditional waiver and release of all liability pursuant to the terms herein, and agreement as to all terms and conditions contained above. I am of lawful age and competent to sign this affirmation. I understand that yoga includes physical activity and, as with all physical activity, there is the risk of injury of varying types and degrees, which risk cannot be entirely eliminated. If I experience any pain or discomfort, I agree that I will discontinue the activity, and ask for support from the instructor. I assume full responsibility for any and all damages which may be incurred as a result of my participation in the yoga activities. I understand that yoga is not a substitute for medical attention, examination, diagnosis or treatment, nor is yoga recommended or safe under certain medical conditions. By signing, I affirm that a licensed physician has verified the status of my health and physical condition as sufficient to allow me to participate in the physical activity required by the yoga program. I agree that I will make the instructor aware of any medical conditions or physical limitations before class. If I am pregnant, become pregnant or I am post-natal or post-surgical, my signature verifies that I have my physician's approval to participate. I also affirm that I alone am responsible to decide whether to practice yoga and my participation is at my own risk. I agree to irrevocably release and waive any claims that I have now or may have hereafter against Yogimemes llc, Pedro Luna, Sumer Luna, Synergy Yoga, Francisco Morales Bermudez, or Salim Rollins, and any additional instructors. In case of an emergency and in the event that your emergency contact cannot be reached, I authorize the staff with Yogimemes llc, Pedro Luna, Sumer Luna, Synergy Yoga, Francisco Morales Bermudez, or Salim Rollins to obtain whatever medical treatment is deemed necessary for my welfare. I further understand and agree that I will be financially responsible for all charges and fees incurred in the rendering of said emergency treatment regardless of whether or not my insurance would cover such charges and fees. By selecting I agree below this is proof of my intention to execute a complete and unconditional waiver and release of all liability pursuant to the terms herein, and agreemtn as to all terms and conditions contained above. I am of lawful age and competent to sign this affirmation. I herewith affirm that my electronic signature, and all future electronic signatures, were signed by myself with full knowledge and consent and am legally bound to these terms and conditions. I HAVE FULLY INFORMED MYSELF AS TO THE CONTENTS OF THIS RELEASE AND HAVE READ THE SAME PRIOR TO MAKING MY SELECTION BELOW.