Participation Information Form

Participant Form

Completing this form is compulsory for all participants attending the Bali retreat(s).

Personal Details

* Indicates required field

Name *

First

Last

Email *

Mobile No. while in Bali *

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) *

Flight Information

Flight No. (arrival at Denpasar) *

Flight arrival time *

Flight No. (departure from Denpasar) *

Flight departure time *

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 along with hiking excursion. 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 up to 3 weeks prior to commencement date. If this is to occur, Kookaburra Yoga will notify me in advance and give me a full refund within 30 days of cancellation.
Kookaburra Yoga may cancel or postpone the retreat 0-3 weeks prior to the commencement date if there is a high risk of natural disasters or Acts of God making travel untenable or the retreat unsafe.
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 Essential Retreat Organiser.
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

We ask for a deposit of $600 upon booking. Your $600 deposit is your commitment to attend and is generally non-refundable unless we can offer your place to a waitlisted person or you find someone to take your place.
If you cancel 0-4 weeks before the retreat the full amount is payable.
If you cancel 4-12 before the retreat 50% of your payment (minus deposit) will be refunded to you.
If you cancel more than 12 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 the death of someone close to you, 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. It is your responsibility to ensure you have adequate insurance to cover the costs of cancellation.
In the event the retreat is cancelled by the organisers 3 weeks or more before the commencement date all money paid will be refunded to you.
If the retreat is cancelled by the organisers 0-3 weeks prior to the retreat because of natural disasters or acts of god which the organisers deem to make the retreat, or travel to and from the retreat, unsafe, then a full refund will not be possible and you will need to claim a refund from your travel insurer. In this event, the organisers will advise what portion of your payment can be recovered and refunded to you. The organisers will endeavour to reschedule the retreat for a future date and give you the option of transferring your booking and money paid to the new retreat date.

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.
I understand that it is a condition of participation in this retreat to organise my own comprehensive insurance and provide the retreat organisers with the certificate of currency prior to the retreat commencement date.
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 excursions organised on 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

yoga in harmony
with nature.

Participant Form​