YOGADVENTURE REGISTRATION FORM Name:____________________________________________________________ Address:__________________________________________________________ _________________________________________________________________ Contact Info: Telephone__________________ Cell________________________ Email:____________________________________________________________ Single:__________________________ Double:___________________________ Tent:___________________________ Bungalow:_________________________ Yoga experience:________________________________________________________ Travel experience:___________________________________________________ Special conditions, allergies, food preferences:____________________________ _________________________________________________________________ Emergency contact:_________________________________________________ Please read carefully: I am aware that BREATHE, Inc., an Illinois corporation, and Akal Yoga are here to serve me by sharing knowledge of yoga, meditation and health. By my participation in BREATHE, Inc. or Akal Yoga classes, activities or journeys, I agree to take full responsibility for not exceeding my limits in the practice of yoga and for any injury I might suffer in the company of Breathe, Inc. or Akal Yoga. I recognize that such activities may require physical exertion, which may be strenuous and may cause physical injury and I am fully aware of the risks and hazards involved. It is my responsibility to ascertain that there is no medical reason to prevent my participation. In consideration of this, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the activities. In further consideration of participating in the class, I knowingly, voluntarily and expressly waive any claim I may have against Breathe, Inc. for injury or damages that I may sustain as a result of participating in the class. I have read the above release and waiver for BREATHE, Inc. and Akal Yoga and waive any claim that I might have at any time for injury of any sort against BREATHE, Inc. or Akal Yoga or any person or entity in any way involved therewith. Signed __________________________________________________________ Date____________