South India Retreat Participation Form

Participant Form
Kerala, South India Retreat

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 *

Date of Birth *

Flight Details

Arrival Flight Number *

Flight Date & Arrival Time *

Departure Flight Number *

Departure Date & Arrival Time *

Extra nights

Do you require extra nights at beginning of tour *

yes no

Do you require extra nights at end of tour? *

yes no

Dates of extra nights *

Emergency Contact Details

Name *

First

Last

Phone Number (with country and area code) *

Any additional information

Comments *

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.
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 travel agent in India for the purposes of organising transfers and booking accommodation.
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 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.In 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.

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 sightseeing 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

Participant Form​ Kerala, South India Retreat