Name *

As it appears in your passport.

First Name

Last Name

Emergency contact *

First Name

Last Name

Are you a smoker? *

Yes

No

Disclaimer *

I herby acknowledge that everything stated in this form is true and correct and I have not omitted any information that may affect my attendance at Rest In The Beat 2025. I hereby acknowledge that as a retreat participant I assume complete and full responsibility for my participation at Rest in the Beat Conscious Dance Retreat Bali, June 15th to 21st 2025, and I release, indemnify and hold harmless Theva Indrasenan, Laura Cargill, Dancing Dhevas, its crew members or anyone involved in supplying any services during the length of the retreat from any and all liability in connection with any loss, damage, claims or injury to me (including any loss or injury caused by negligence) arising from my participation to the retreat. I accept complete responsibility for attending the retreat, its activities and any optional activities/ceremonies and I understand that Dancing Dhevas, Theva Indrasenan and Laura Cargill shall not be responsible for any losses or damages, injuries, diseases, accidents or health related problems or any other problems that result or may result directly or indirectly from the activities/ceremonies/yoga/dance/meditation or from any other experiences or aspects linked to the retreat, such as accommodation, food, walk or travel. I am aware that it is the participants’ responsibility to obtain appropriate insurance coverage against these risks. I understand that if travel plans are delayed or cancelled for any reason there will be no refunds issued by Dancing Dhevas, except as stated herein. I acknowledge that Dancing Dhevas, Theva Indrasenan are not responsible for expenses incurred in preparation for any cancelled trips by a participant. I understand that the organisers and the retreat venue do not tolerate ill behaviour, including but not limited to violence, aggression, alcohol consumption at the centre and harassment of participants or staff at the retreat venue and therefore reserve the right to cancel my attendance at any point and remove you from the centre. Furthermore, I agree to the cancellation policy as stated below: I understand that Theva Indrasenan and Laura Cargill are not responsible for any aspects of the trip, either prior to or following the retreat, other than the retreat itself beginning upon arrival at the retreat centre.
 I also agree to allow Theva Indrasenan and Dancing Dhevas to use photos, which may include myself as a participant for promotional purposes only at my own discretion. By signing my name below, I confirm that all of the above information is correct to the best of my knowledge, I have read, understood and acknowledged everything stated in this form and I will inform the teachers/managers of any change in my circumstances.

I Accept, agree and will sign a hard copy either on or before 15th June 2025