Name *

First Name

Last Name

Date of birth *

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

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Date of initiation into Neelakantha Meditation *

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DD

YYYY

Emergency contact *

First Name

Last Name

Phone of emergency contact *

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Liability Waiver *

I hereby agree to the following: I am, out of my own accord, participating in the Blue Throat Yoga Maṇdala of Practices held In Keene, NY from October 20 through 22 of 2023, during which I will receive instruction in the practice and teachings of meditation and yoga. I understand and agree to the following. Please read the following points carefully. Your submission of this form is your consent to each point in the agreement.

It is my responsibility to take care of my body and communicate in a timely way any issues or concerns with the teachers in charged for the Mandala.

I represent and warrant that I have no medical conditions that would prevent my safe participation during the Mandala.

I assume full responsibility for any risks, injuries, disease or damages, known and unknown, that may occur during arrival or departure from the premises, and while participating in the Mandala.

In consideration of being able to attend the Mandala, I knowingly, voluntarily and expressly waive any claim I have against the teachers or Blue Throat Yoga, for injury and damages that I may sustain as a result of participating in the Maṇḍala program. This release waives any provisions, covenants or existing laws that provide that a general release does not extend to claims, which the creditor does not know to exist in his/her/their favor at the time of executing the release, which if known to him/her/them, must have materially affected his/her/their settlement with the debtor.

I, my heirs or legal representative, forever release, waive, discharge and covenant not to sue the Blue Throat Yoga teachers or the Blue Throat Yoga School for any injury caused by their perceived negligence or other acts.

I have read read and agreed to the above listed release and waiver liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.

By submitting this form I am attesting that I have read, understood, and agreed to the points stated above.