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Participant Form
Dharamsala Retreat 20 April - 4 May 2017
Completing this form is compulsory for all participants attending the India Retreat
Personal Details
*
Indicates required field
Name
*
First
Last
Email
*
Mobile No. while in India
*
Submit photo of first page of Passport
*
Max file size: 20MB
Submit Insurance Certificate of Currency
*
Max file size: 20MB
Food allergies, dietary restrictions
*
Relevant medical history, any current medications, recent or past injuries
*
Emergency Contact Details
Name
*
First
Last
Phone Number (with country and area code)
*
Terms and Conditions
I understand and agree:
that my deposit is non-refundable and I have read and understand the Cancellation and Refund Policy.
I must complete and return this form prior to the retreat or on arrival and I understand it is a requirement of participation in the retreat to provide correct information and to have comprehensive travel insurance with relevant inclusions.
that I am participating in a moderately active retreat and may find it physically challenging at times. There will be one or more yoga/meditation classes daily. The onus is on me, the participant, to ensure that I am physically fit to undertake the activities.
I take full responsibility for my own health and well-being during the retreat. I understand Kookaburra Yoga and the retreat facilitators are not responsible or liable for any injuries or other medical or emotional problems if they occur. I understand that participation in programmed retreat activities is at my own discretion and is not compulsory.
Kookaburra Yoga reserves the right to cancel the retreat. If this is to occur, Kookaburra Yoga will notify me in advance and give me a full refund within 30 days of cancellation.
I understand that Kookaburra Yoga isn’t responsible for any additional expenses incurred in relation to this retreat which are not specifically referenced in the itinerary, nor any medical and preparation expenses.
Kookaburra Yoga shares information in this form and information collected from participants with third party tour organiser India Easy Pty Ltd
Kookaburra Yoga will not share any information contained in this form with any other 3rd party without my permission, unless there is a medical emergency and the retreat organisers deem it necessary.
Cancellation & Refund Policy
A deposit of $700 is required upon booking a place on this Retreat and confirms your place and room option selected.
Your deposit is your commitment to attend and is generally nonrefundable unless we can offer your place to a waitlisted person or you find someone to take your place.
I
n exceptional circumstances we will also refund the deposit.
If you cancel 0-2 weeks before the retreat the full amount is payable.
If you cancel 2-4 weeks before the retreat 75% of your payment (minus deposit) will be refunded to you.
If you cancel more than 4 weeks prior to the retreat your full payment (minus deposit) will be refunded to you.
If you need to cancel due to ill health or unforeseen circumstances, your travel insurance policy may refund your deposit and all other money paid back to you. Please check with your insurer.
Travel insurance on this retreat is compulsory.
If we have a waitlist and can fill your place from this, all money paid (except for deposit) will be refunded to you regardless of when you cancel.
Release of Liability Agreement
I understand and accept that Kookaburra Yoga and the retreat facilitators are NOT liable for any injury or damages to person or property – travelling to and from this retreat, and while participating in this retreat.
Kookaburra Yoga provides a safe environment for yoga facilitated by experienced teachers, and I agree my participation in yoga and meditation is at my own discretion and accept full responsibility for any loss or injury incurred. I agree to participate in the hiking and travelling components of this retreat at my own discretion and accept full responsibility for any loss or injury incurred.
I have read the Terms and Conditions and understand and accept them. I understand that it is compulsory to accurately complete and return this form prior to the retreat.
By submitting this form I am agreeing to:
Terms and Conditions
Cancellation and Refund Policy
Release of Liability of Kookaburra Yoga
Submit
home
about
Our Yoga
Our Place
Our People
Calendar
Counselling
Social
Gift Cards
retreats
About our retreats
Retreats Calendar
Sound Silence Stillness 1-Day
Devotion Evening Retreat
India Longevity Yoga Ayurveda Retreat Kerala - 12 day
>
About Longevity, Yoga & Ayurveda
Longevity Retreat Options + Costs
New Year's Eve Sound Silence Stillness Retreat
Bali Women's Sacred Healing Retreat - 7 day
Kookaburra Yoga Stay Personal Retreat
classes
About our Classes
timetable
Booking Calendar
Memberships & Passes
Weekly Classes
Private Classes
Kids Yoga
LiveLighter Free Yoga Classes
Teachers
courses
About Our Courses
Absolute Beginners Yoga
Yoga Relax Meditate Course
Introduction to Meditation
teacher training
Meditation Mastery Teacher Training 2025 - 6 months 200hr
Yoga & Meditation Teacher Training 2024 - 12 months, 500hr
Yoga & Meditation Teacher Training 2026 - 12 months, 500hr
events & workshops
Kirtan Evening Friday PM Monthly
Shakti Womens Circle Saturday am monthly
Soma Yoga Healing Saturday eve monthly
Yogic Living Cooking Workshops
Corporate & Private Groups
Contact