Spring Yoga Retreat at Green Gulch Zen Center with Jennifer Barone

April 19th, 2020 – Retreat Registration

To Register, please complete:

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First Name

Last Name

Email Address

Home Address (+ apt #)

City

State

Zip Code

Phone Number

Emergency Contact Name

Emergency Contact Phone Number

Do you have a car and can you take passengers to the retreat?

Do you need a car pool?

Describe your personal yoga practice (familiarity with styles and time practicing):

Describe your current health condition: (including pregnancy (# of months), injuries (specify), medical conditions or medication(s) including the effects of medication:

I agree to the general Release Form: Yoga instruction through Inner Lotus and its instructor, Jennifer Barone (“Releasee”) are designed for students who are generally in good health. Yoga and yoga therapy are designed to be an integral part of a total wellness program and not intended to take the place of health care provided by a doctor. I acknowledge that I have spoken to my doctor or health care provider before taking part in lessons through Inner Lotus and its instructors. I acknowledge and understand that a risk of personal injury may be involved in any exercise program. I understand and accept that in order to properly teach and correct yoga technique, physical contact in a professional manner between student and instructor may be necessary. I consent to such contact as is considered necessary by the instructor or will accept responsibility for notifying the instructor(s) of my concerns about such physical contact prior to engagement of lessons through Inner Lotus and its instructors. By signing this document, I release “Releasee” from all liability to me for any loss or damage to property or injury or death to person, whether caused by “Releasee” or otherwise and I I assume full responsibility. I understand that I am entitled to no refunds, credits or adjustments for any reason. I acknowledge that I have read and understand and I voluntarily sign this document.

First Name / Last Name (Digital Signature)

Today's Date

Thank you for registering!
After you press the “Submit” button, you will receive an email confirmation with further information and details on the retreat.

To complete your registration, please send payment:
$145 – if registering before March 18th
$155 – after March 18th

Payments can be made with Paypal, Venmo:

Personal check can be made out to: Jennifer Barone.
Please email Jennifer directly with any questions or concerns.

InnerLotus Yoga

Yoga, Energy Healing, Workshops and Retreats