Participant Information

Name *

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone *

(###)

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Receives text messages? *

Yes

No

Alternate Phone

(###)

###

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Emergency Contact Phone

(###)

###

####

Secondary Emergency Contact Phone

(###)

###

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WAIVER OF LIABILITY AND ASSUMPTION OF RISK for Love Offensive Photography + Yoga Destination Travel Retreats *

I have voluntarily joined a Love Offensive yoga and photography retreat to Alaska. I understand that there may be differences between this state and my own, including climate, culture, food and transportation, among others. I understand that traveling in urban and rural areas assumes certain risks, for which the Love Offensive is not responsible. I have fully informed the Love Offensive staff of any condition of my mental or physical health that might affect my participation in the trip. I understand that the Love Offensive and its leaders are not responsible for my health care or coverage, either during the trip or afterwards. I understand that there are no guarantees against personal injury or death while part of a Love Offensive trip. With this understanding, and in consideration for my participation in a Love Offensive trip, I completely accept and assume all responsibility for any and all risks of damage, sickness, theft of personal property or personal injury which may occur during, or resulting from my participation in the program, including, but not limited to, those risks described above. In signing this document I expressly release, discharge, and hold harmless the Love Offensive and all staff/leaders involved with planning, organizing and facilitating the trip to the maximum extent permitted by law in any state, territory, district, or country. I have read and understand the foregoing and sign it voluntarily. I am at least eighteen years of age, of sound mind and act of my own free will and without any coercion or duress in signing this WAIVER OF LIABILITY AND ASSUMPTION OF RISK.

I do not agree.

I have read and understand the foregoing and sign it voluntarily.