Mother’s Day Weekend Retreat Santa Barbara

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1 Welcome

3 People in your group

4 Participant Info

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Email newsletter	Please send me the email newsletter
Comments or Special Needs
Special Diet *
Diet Notes *	NOTE: Please indicate any food allergies or special requests not already listed elsewhere.
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Medical / Mental Health	NOTE: Please let us know if you have any medical or mental health concerns we should be aware of, and if you are being treated for them.
Emergency Contact Info *
Terms and Conditions *	I have read and accept the terms and conditions.Please read the terms and conditions
How did you hear about us? *
E-Signature: Photo & Media Consent *	By clicking 'Yes,' I grant and authorize TwoCan Retreats the right to take, edit, alter, copy, exhibit, publish, and make use of any and all pictures or video taken of me (or my minor child) for use in TwoCan Retreats post-retreat recaps and other promotional purposes. A PDF version is attached for your convenience.
E-signature: Enter your full name *	Electronic Signature By entering your name here, the undersigned has read, considered and expressly agreed to all of the terms and conditions of this Waiver and Release of Liability Agreement, as of the date of its electronic timestamp. A PDF version is attached for your convenience (and reads as follows): I [retreat participant], have chosen to participate in a retreat with TwoCan Retreats. I understand that the purpose of the Release of Liability Agreement set forth herein is to protect TwoCan Retreats, its employees and contractors from any and all liability which may arise from, or be related to, my participation in the retreat. TwoCan Retreats group insurance provides general liability insurance only. If you are traveling, we strongly recommend that you also purchase travel insurance through your travel agent or other provider. This insurance should protect against sickness, injury, lost luggage, missed flights, trip cut short, and many other unforeseeable issues that may arise while traveling and/or participating in a retreat. TwoCan Retreats does NOT accept responsibility or provide refunds for any of the above occurrences. I understand that there are certain dangers and risks inherent in travel, excursions and activities included in the retreat, and that TwoCan Retreats does not assume responsibility for losses including, but not limited to, personal injuries or property damage, loss or theft. These risks may include losses related to travel to and from the destination; the condition of the facilities where the program occurs; criminal activity; the defect of a vehicle or the negligence of an employee; sickness, weather, strikes, hostilities, wars, natural disasters, or other such causes; and any disruption of travel arrangements, or any additional expenses that may be incurred. I further understand that TwoCan Retreats does not represent, or act as an agent for the transportation carriers, facilities, or other suppliers of services in connection with TwoCan Retreats. Knowing the dangers and risks of such activities, I on behalf of my family and personal representatives, agree to assume all risks and responsibilities surrounding my participation in the retreat and all related excursions and activities. I agree to refrain from any activities I do not believe I am capable of participating in, due my own physical or emotional capacity and limitations. I further agree to abide by the terms and conditions of this Agreement. Moreover, I agree to hold TwoCan Retreats free and harmless from any claims, demands, or suits for damages from any injury or complications whatsoever, save negligence, that may result from my participation in ant TwoCan Retreats activities. Medical Treatment I consent to medical treatment and medical services that may be required if an injury occurs on-sight. I further acknowledge that in the event medical treatment be required, that my agent or responsible party be required to pay for any medical expenses incurred. TwoCan Retreats is not responsible for the cost of medical treatment. Successors I understand and agree that this RELEASE, WITH ACKNOWLEDGEMENT AND ASSUMPTION OF RISKS shall be binding upon myself and all of my heirs, assigns and next of kin and shall extend to the benefit of Released Parties and their successors and assigns. Personal Responsibility I do not, to the best of my knowledge, have any physical limitation, medical ailment or mental disability that would prevent me from participating in the above-mentioned operations and activities. It is my responsibility to disclose any and all impairments that may impact my ability to perform. If any provision of this Waiver and Release of Liability Agreement shall be held unenforceable or void, it shall be severable from the remaining provisions and shall not affect their subsequent enforceability or validity. Adherence to Policies I hereby agree to abide by all rules, regulations, and instructions of TwoCan Retreats while participating in all TwoCan Retreats-related activities. I understand that TwoCan Retreats may choose to refuse service to anyone, and if I am in violation of the policies, I may be asked to cease involvement. I understand and agree that TwoCan Retreats reserves the right to accept or deny service to any person, at any time, and for any reason. Lastly, I agree that this Release of Liability Agreement shall be governed and interpreted in accordance with the laws of the State of California.

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