Agreement of Release and Waiver of Liability

Name: _______________________________________________________________

Address: _____________________________________________________________

City:______________________________ State/Province:_______________________

Zip Code: _________ Country: ____________________________________________

Phone:   ________________________________________ DOB: _________________

Email: ________________________________________________________________

Nationality: ________________________ Passport Number: _____________________

Emergency Contact Name/Relation: ________________________________________

Emergency Contact Phone: _______________________________________________

List any physical or psychological medical conditions or previous surgeries: 

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

 

1. I am, or will be participating in the yoga classes or health Programs or workshops or Retreats (“the Programs”), offered by DIHEDRAL YOGA, LLC and PERU ANDES DISCOVERY incorporated under the laws of Florida, USA having its registered office at 1180 26th Ave N, Saint Petersburg, FL USA acting for itself or any third party directly linked with DIHEDRAL YOGA, LLC, and PERU ANDES DISCOVERY during which I will receive information and instructions about yoga, well-being, and health. These Programs may entail intensive physical activity (including but not limited to yoga activities and hiking) and exertion by myself. I recognize that such physical activity and exertion may be difficult and strenuous and may cause or aggravate a physical injury or medical condition. I am fully aware of and accept the risks and hazards involved. 

2. I understand that it is my responsibility to consult with and I herewith warrant that I have consulted with a certified physician or doctor prior to and regarding my participating in the Programs. I have received prior unconditional approval to participate in the Programs from a certified physician or doctor. I represent and warrant that I am physically fit and have no medical condition or injury which would prevent my full participation in the Programs. 

3. In consideration of being permitted to participate in the Programs, I agree to assume full responsibility for any risks, conditions, injuries, or damages, known or unknown, which I might incur or aggravate as a result of my participating in same. 

4. In further consideration of being permitted to participate in the Programs, I knowingly, voluntarily, unconditionally and expressly release and waive any claim and/or demand I may have or acquire against DIHEDRAL YOGA, LLC, and/or PERU ANDES DISCOVERY for any injury, losses, condition, direct or indirect damages, or personal damages that I may sustain as a result of entering or being on the premises or participating in the Programs. Any and all express or implied warranties (whether by law, by advertising, or resulting from the Programs) regarding the Programs are expressly excluded and disclaimed by DIHEDRAL YOGA, LLC and PERU ANDES DISCOVERY.   

5. I, my heirs, or legal representatives do hereby forever and unconditionally release, relinquish, waive, discharge, and covenant not to sue DIHEDRAL YOGA, LLC and/or PERU ANDES DISCOVERY or the landlord of any premises at which it may operate, for any injury, condition or death, any losses, personal damages, or direct or indirect damages that may arise or is caused by, or is aggravated by reason of my entering to, or participation in the Programs, or being on the premises. 

6. I understand that it is my continuing responsibility to inform the instructor(s) during the Programs of any previous medical conditions, injuries, or surgeries prior to my first class, and at such other times as I acquire information as to the same. Please list the previous conditions, ailments, injuries and/or surgeries. 

7. DIHEDRAL YOGA, LLC and PERU ANDES DISCOVERY may contract with independent contractors to provide transportation, guide services and/or all other related travel services. DIHEDRAL YOGA, LLC and PERU ANDES DISCOVERY assume no responsibility, however caused, for injury, loss, or damage to person or property in connection with any service provided by an independent contractor or resulting directly from the following, but not limited to: acts of God, detention, annoyance, war, terrorism, thefts, pilferage, force majeure, civil disturbances, government restrictions or regulations, strikes, delays and expenses arising from quarantine, failure of any means of conveyance to arrive or depart as scheduled, discrepancies or change in transit or hotel services over which we have no control. 

8. DIHEDRAL YOGA, LLC and PERU ANDES DISCOVERY reserve the right to make reasonable changes in the itinerary where deemed advisable for the comfort and well-being of the Programs members. 

9. I, my heirs, or legal representatives forever and unconditionally release, waive, discharge, and covenant not to sue DIHEDRAL YOGA, LLC and/or PERU ANDES DISCOVERY or the landlord of any premises at which it may operate for injury, loss or damage to person or property in connection with any service provided by an independent contractor or resulting directly from the following, but not limited to: acts of God, detention, annoyance, war, terrorism, thefts, pilferage, force majeure, civil disturbances, government restrictions or regulations, strikes, delays and expenses arising from quarantine, failure of any means of conveyance to arrive or depart as scheduled, discrepancies or change in transit or hotel services over which we have no control. 

10. I understand that this Agreement of Release and Waiver of liability is valid during the whole period of the Programs, and is not limited to the time that I spend at the DIHEDRAL YOGA, LLC, and PERU ANDES DISCOVERY premises. I understand that this Agreement of Release and Waiver of liability is valid and shall also apply to claims, claims for injury, losses, direct or indirect damages, personal damages that I may suffer or assume after the period of the Programs but which are based on events originating from or took place during the period of the Programs. 

11. WAIVER AND RELEASE OF LIABILITY: I hereby WAIVE AND RELEASE ALL LIABILITIES, CAUSES OF ACTION, CLAIMS AND DEMANDS against DIHEDRAL YOGA, LLC and/or PERU ANDES DISCOVERY, its employees, officers, directors, vendors and contractors ("Released Parties"), where such LIABILITIES, CAUSES OF ACTION, CLAIMS AND DEMANDS arise in any way from any injury, death, loss or harm (whether foreseen or unforeseen) that occur to me or to any other person or to any property during the Programs or are in any way related to the Programs. This release includes, but is not limited to, claims for the negligence of the Released Parties and claims for strict liability for abnormally dangerous activities. This release does not extend to claims for gross negligence, intentional or reckless misconduct, or any other liabilities that Florida law does not permit to be released by agreement. I also agree NOT TO SUE or make a claim against the Released Parties for death, injuries, loss, or harm that occur on the Programs. 

12. INDEMNIFICATION HOLD HARMLESS AND DEFENSE: I promise to INDEMNIFY, WARRANT, HOLD HARMLESS AND DEFEND the Released Parties (defined in Section 11) against any and all LIABILITIES, CAUSES OF ACTION, CLAIMS AND DEMANDS that arise from my acts or my failure to act (including my own negligence) during or relating to the Programs. In accordance with this promise, I will reimburse the Released Parties for any damages, reasonable settlements and defense costs, including attorney's fees, that they incur because of any such claims made against them. I agree that in the event of my death or disability, the terms of this agreement, including the indemnification obligation in this Section, will be binding on my estate, and my personal representative, executor, administrator or guardian will be obligated to respect and enforce them.

13. DIHEDRAL YOGA, LLC, and PERU ANDES DISCOVERY shall not be liable for failure of travel service suppliers, including but not limited to airlines or hotels to perform the services offered by such suppliers. DIHEDRAL YOGA, LLC and PERU ANDES DISCOVERY, do not guarantee or insure the services to be provided by any supplier, the financial position of such suppliers or the reimbursement to me from any loss experienced as a result of the financial condition of such supplier. Except as expressly stated herein, DIHEDRAL YOGA, LLC, and PERU ANDES DISCOVERY assumes no responsibility for actions relating to travel services beyond the control of DIHEDRAL YOGA, LLC and PERU ANDES DISCOVERY or its employees. DIHEDRAL YOGA, LLC and PERU ANDES DISCOVERY are not responsible or liable for any act of God, error, omission, injury, loss, accident, damage, delay, nonperformance, irregularity, or any consequence thereof, which may be occasioned through neglect, or default or any other act or inaction of any supplier of travel products. 

14. A deposit of $1200.00 of the total per person cost of the booking for double rooms or a deposit of $1500.00 of the total per person cost of the booking for single rooms is due along with this executed agreement. The deposit is non-refundable. 

15. After payment of the initial deposit, you will receive a booking email with instructions to pay your total retreat payment, minus deposit paid. This remaining balance is due July 1, 2020. If you are booking after July 1, 2020, your full payment will be due within 48 hours after your deposit. 

16. If your second payment is not received on time, your initial deposit is subject to forfeit. 

17. Any credit card payments are accepted with a 3% fee. 

18. One-half (50%) of your total booking cost will be refundable until DATE TBD after which point the entire balance is wholly NON-REFUNDABLE. You may transfer your reservation to another individual who is not already registered for a retreat. 

19. No postponements or credits are available. 

20. I also understand that I have no claims against DIHEDRAL YOGA, LLC and PERU ANDES DISCOVERY, except for monetary refund by reason of refusal to allow me to participate in the Programs. 

21. This Agreement, Release and Waiver of liability shall be governed and interpreted in all respects by the law of FLORIDA USA without regard to any conflict of law provisions, and, where applicable, shall be subject to compliance with the laws, rules and regulations of FLORIDA USA, without regard to its conflicts of law provisions and rules. Subject to the provisions of this clause, I agree that the competent court in FLORIDA USA shall have exclusive jurisdiction to settle any dispute which may arise in connection with the creation, validity, effect, interpretation or performance of, or the legal relationships established by the Agreement or the Programs or otherwise arising in connection with the Agreement or the Programs. I irrevocably waive any objection which I may have now or in the future to the courts of FLORIDA USA being nominated for the purpose of this clause on the ground of venue or otherwise and agrees not to claim that any such court is not convenient or appropriate forum. I herewith also waive any right to a trial jury. 

22. I hereby grant permission to DIHEDRAL YOGA, LLC, and PERU ANDES DISCOVERY for the rights of my image and/or likeness without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse settings within an unrestricted geographic area. By signing this release I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the internet or in a public educational setting. I will not be consulted about the use of photographs or video recording for any purpose other than those listed above. There is no time limit on the validity of this release nor is there any geographic limitations on where these materials may be distributed.

23. By advancing deposit to DIHEDRAL YOGA, LLC, the depositor thereby agrees to be bound by the above terms and conditions. 

 

Things to note:

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If you travel in high altitude environments to which you are not accustomed you may experience symptoms of altitude sickness, Symptoms usually include nausea, headache and a loss of appetite, but can be more serious. If this occurs, you must inform your guide(s) immediately. More serious forms of altitude sickness include High Altitude Pulmonary Edema (HAPE) and High Altitude Cerebral Edema (HACE) can be fatal if not treated quickly and effectively. Effective treatment will require rapid descent to a lower altitude, which may be difficult due to a variety of factors. 

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Average daytime temperatures in and around Cusco generally range from 55 - 80 degrees F with Andean evenings cooling down to anywhere between the 20s and 50s. The itinerary takes place in the mountains where the weather can change very quickly. During the months of May-October, days are typically clear and pleasant, with afternoon clouds occasionally building and leading to small amounts of precipitation. All day rain is unlikely. 

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If during the Programs, I am rendered unconscious or incompetent or otherwise cannot effectively make decisions regarding my medical care, I authorize in advance the provision of any emergency medical treatment deemed necessary or advisable for me. I also authorize DIHEDRAL YOGA, LLC and/or PERU ANDES DISCOVERY, and its employees and contractors to make health care decisions for me and to give or withhold informed consent to health care on my behalf at any time during the Programs  when my family members or emergency contact are absent or unable to make such decisions. I agree that I will pay for all medical treatment that I receive, including any evacuation whether directly or through reimbursement to DIHEDRAL YOGA, LLC and/or PERU ANDES DISCOVERY. 

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I verify that all of the preceding information is correct, I agree that it can be shared with guides and other service providers during the Programs, and I agree to the preceding consent and authorization of medical treatment. 

 

I have read the above terms and conditions of the Agreement of Release and Waiver of Liability and fully understand its contents and the consequences thereof. I voluntarily agree unconditionally to the terms and conditions stated above.

 

⬜ By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

 

 

 

________________________________________                          ____________________

Signature:                                                                             Date:

 

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