Your Name: Company Address City State Zip Code Country E-mail Phone Your Fitness Level: Height/Weight: T-shirt/Shoe size
Emergency Contact: Relation to Applicant: Emergency Contact Phone Number:
Insurance Carrier Policy Number Company Phone Company Address
Arrival Date & Time Airline & Flight Number Departure Date & Time Airline & Flight Number Do you require a pick-up from Canyonlands Field Airport?
We recommend that you consult your physician regarding your participation in one of our retreats. Please contact us if you have ANY questions regarding your ability to participate. What is your present state of health? Do you have any pre-existing medical conditions? Do you currently take any medications and if so, which ones? Do you have any pre-existing injuries we should be aware of? Are you pregnant and if so, how many months? Do you have any allergies? Do you require Vegetarian fare?
Please note that each of our retreats vary in difficulty (see descriptions). What kind of physical condition would you say you are in? Include activities in which you participate in and the frequency of each activity. How many times a week do you practice yoga?
What most interests you about our retreats? What would you like to get out of this experience? Do you have any experience hiking at elevations above 5,000 ft? If so, when and where? (No experience is required). *For Base Camp / Backpack Retreats Only* What fuel type do you use for your stove? Do you have any experience rock climbing? Please explain. (No experience is required) Do you have any concerns or apprehensions about our retreats? How did you learn about us? Comments
All outdoor recreational activities include risks integral to those activities. Although it is possible to minimize these inherent risks, they cannot be eliminated without destroying the unique nature of the activity. Activities occur in the wilderness. Environments include canyon, mountain and desert terrain remote from medical facilities, roads and communication sites. Moab Yoga on the Rocks makes reasonable efforts to manage the risks, but does not provide a guarantee of a risk free experience. Some, but not all, of the inherent risks of outdoor activities that you may be exposed to include, but are not limited to, judgments by self, others, or Moab Yoga on the Rocks; not following instructions, falling or stumbling, rough and steep terrain, trails with or without maintenance, off-trail (cross-country) travel, fences and barbed wire, loose rock, sand, sharp branches, cactus, vegetation, boulders, exposed ledges and paths, standing or running water, flash flood conditions and rock fall.
Some, but not all, of the unforeseeable risks you may be exposed to include flash flood, rain, snow, lightning, extreme weather changes, winds, high temperatures, wild animals, venomous reptiles, insects, obscure hazards, downed trees, steep slopes, and terrain lacking water sources.
These and other risks and hazards can result in injury, damage, permanent disability, death, or loss. All participants should wear proper clothing and footwear and carry water for the duration of the outdoor activity, recognizing the responsibility they have to be prepared for a variety of conditions and terrain. By voluntarily signing up to participate in any organized retreat or workshop, participants acknowledge the presence of these and similar risks.
