Medical Form

(Strictly confidential and only used during emergencies)

 

Name:_________________________________________________________________________

 

D.O.B:_______________________________

 

Do you take any regular medications?_______Yes__________No

If yes, please list medication and reason:

 

 

 

 

 

 

Do you have: diabetes___________________________________________________

 

hypertension_______________________________________________

 

respiratory disorders (COPD, asthma)___________________________

 

suffer from motion sickness in vehicles__________________________

 

have a limiting physical disability______________________________

 

suffer from arthritis or rheumatism_____________________________

 

Do you have allergies to food or medication_________________________________

If yes, what sort of reaction do you experience and what do you do to alleviate symptoms?

 

_____________________________________________________________________

 

Are you vegetarian or vegan or have any specialized dietary needs?_______________

 

_____________________________________________________________________

 

_____________________________________________________________________

 

Do you have any concerns about anything else which could affect your ability to undertake the trip on which you are booked?_____________________________________________

 

 

Declaration: I declare that the information given is, to the best of my knowledge, correct and I feel I am capable of undertaking and completing this trip. 

 

Signed:____________________________________________________________________

 

Date:_____________________________________________________________


 

 

PARTICIPANT TOUR AGREEMENT

Date: June 20, 2019

Welcome!

My mission with Kajal India Tours is to provide a unique and intimate experience of India to those who want to explore culture in a relaxed and flexible manner. 

Why You’re Reading This Document

The purpose of this Participant Retreat Agreement (the “Agreement”) is to communicate our mutual expectations for your experience in India (the “Retreat”). One of my biggest concerns is that you need to acknowledge the risks of physical activity and foreign travel and agree that you can’t sue me if something happens to you. There are other juicy parts but I won’t spoil too much! Away we go! 

Parties. This Agreement is made between Julie Price, the owner/operator of Kajal India Tours (P.O. Box 876, Crofton, B.C. V0R 1R0) (“Kajal,” “Me,” “I”) and __________________________ (“You” and “Your”).

What to Expect During the Retreat. Kajal will organize an amazing Retreat with yoga, delicious food, and an intimate experience of Indian culture. All the details in Schedule “A” Retreat Details and Cost. 

What We Expect of You. Just so that everyone is clear, We’ve listed out some (common sense!) guidelines on how you should behave on the Retreat, physical requirements of participating in the Retreat, and other expectations of you. These are outlined in Schedule “B” Retreat Expectations. If you don’t meet these expectations, you may be asked to leave the Retreat immediately. 

Cost and Refunds. In exchange for the Retreat, you will pay the amounts as set out in Schedule “A” Retreat Details and Cost. Information on refunds and payment method are all clearly outlined there. 

Term and Termination. This Agreement begins on the Retreat Start Date and will continue until the Retreat End Date (as those dates are defined in Schedule “A”). If you no longer want to participate in the Retreat, you must provide written notice to us (an email is fine). Note that your termination is subject to the refund policy in Schedule “A.” In the very unlikely event that we need to cancel the Retreat, we will do our best to provide you with as much notice as possible and will provide you with a refund within 14 days of my cancellation notice. We have the right to terminate this Agreement immediately if you fail to adhere to the Retreat Expectations in Schedule “B.”

Legal Things That Are REALLY Important. This is the juicy part! It all sounds very legal-y (and it is!) so we’ve included it in Schedule “C” Waiver, Release and Indemnity. Please read that Schedule and make sure you understand it. You need to sign that Schedule as well as this Agreement so that we can make absolute sure you understand and agree to it. 

Standard Legal Things. Standard legal stuff that is still important! Jurisdiction. This Agreement will be governed exclusively by the laws of the province of British Columbia. Severability. If any provisions of this Agreement is invalid or unenforceable, the other provisions in the Agreement will remain in full force and effect. Entire Agreement. This Agreement constitutes the entire Agreement between the parties and replaces any prior agreements. Waiver of Breach. The waiver by us of any breach by you of any provision of this Agreement will not be taken to be a waiver of any further breaches by you. Notice. For the purpose of this Agreement, e-mail or text will suffice for written notice when required as set out above. Headings. The headings used in this Agreement are for stylistic purposes only and none of the content in the headings are intended to be legally binding. Counterparts. This agreement may be signed in any number of counterparts, each of which is an original, and all of which taken together constitute one single document.

 

 

 

 

____________________________
JULIE PRICE

______________________________
participant signature

Print Name:
 

 

SCHEDULE “A” RETREAT DETAILS AND COST

 

 

Retreat Location

Delhi, UP, Haridwar and Rishikesh, Uttarakhand, India (the “Retreat Centre”)

Retreat Start Date

March 6, 2020

 

Retreat End Date

March 19, 2020

 

Cost (CAD) (incl. tax)

$1995 CAD

 

Deposit

$500 CAD

Payment Plan

$500 CAD deposit due on registration to Julie Price. 

Instalment of $925 CAD to Julie Price by September 1, 2019. 

Final payment of $570 CAD to Dancing Lotus Yoga due on October 1, 2019.

 

Late Payments

There is a $15 late fee for any final payment received after the deadline. A late final payment may result in you losing your spot in the Retreat. 

Payment Method

E-transfer (kajalindiatours@gmail.com) or cheque made payable to Julie Price. Cash/cheque or e-transfer (tracy@dancinglotusyoga.com) to Dancing Lotus Yoga. 

Refunds

Cancellation notice received more than 60 days prior to departure: 100% refund (Jan.5, 2020)

Cancellation notice received 30-60 days prior to departure: refund of balance but not of deposit. (Jan. 6-Feb. 4, 2020)

Cancellation notice received less than 30 days prior to Retreat Start Date: no refund of any monies paid. (Feb. 5, 2020)

If a member must leave the Retreat due to an unforeseen medical emergency, I may in my sole discretion choose to offer a prorated refund for the unused portion of the Retreat. 

Accommodation Details

You will share accommodation with another group member in a double fan room for most of the Retreat. Due to space limitations in our Delhi guest house, you may be in a triple room with 2 singles and a cot. You will share with a member of the same gender unless travelling as a couple. There are no single supplements. All rooms contain two twin or two double beds and have attached bathroom with shower and ceiling fan except as noted above. You are responsible for extra billings due to room service, telephone charges, damage or removal of items from rooms. 

 

Included in the Cost of the Retreat: 

  • Accompanying yoga instructor, local yoga instructor

  • Accommodation

  • 3 meals/day in Haridwar and Rishikesh

  • Breakfast in Delhi 

  • Ground transportation and airport transfers

  • Pre-trip education. 

  • Excursions (Hidden Delhi Tour,Har Ki Pauri; Gujjar village; Anandamayi Ashram, Kunjapuri Trek)

  • Group excursion tips

 

Not Included in the Cost of the Retreat:

  • Flight

  • Travel Health insurance

  • Indian Visa, 

  • Lunch/dinner in Delhi 

  • Stopover costs

  • Charity

  • Phone and email

  • Laundry

  • Restaurant/porter tips

  • Souvenirs and other personal purchases

  • Free time activities

  • Emergency costs

 

 

SCHEDULE “B” RETREAT EXPECTATIONS 

If you do not meet any of these expectations, we have the right to ask you to leave the Retreat and can terminate this Agreement. If that happens, you are not entitled to a refund of any money paid to us. 

  1. Mandatory medical insurance.

  2. You must complete, sign, and return a medical information form. Any pre-existing physical, mental or emotional disability that may require attention or treatment must be reported in writing prior to your Retreat. We regret that we are unable to provide physical assistance or any special facilities for the physically disabled. 

  3. Be respectful of yourself, ourselves, and other Retreat members as well as Retreat Center staff and generally anyone that you come into contact with during the Retreat. 

  4. Follow any rules or policies of the Retreat Center such as noise level requirements, clothing requirements, and in particular any safety rules for use of the Retreat Center’s facilities.

  5. Treat the Retreat Center’s property with respect, including cleaning up after yourself where appropriate, not damaging anything in your room, and other common sense practices. If you damage any of the Retreat Center’s property you are responsible for the full repair and/or replacement cost. 

  6. Demonstrate integrity and responsibility towards your yoga teachers by upholding clear communication. Mean what you say and say what you mean. 

 

SCHEDULE “C” WAIVER, RELEASE, INDEMNITY 

THIS IS IT. THE REALLY IMPORTANT LEGAL STUFF. READ UP, UNDERSTAND FULLY, AND ASK QUESTIONS IF YOU DON’T UNDERSTAND SOMETHING. YOU ARE ABOUT TO SIGN AWAY SOME OF YOUR LEGAL RIGHTS SO MAKE SURE YOU COMPLETELY UNDERSTAND WHAT THIS ALL MEANS. 

  1. Inherent Risks. You understand that participating in the Retreat has inherent risks, some of which may be more obvious than others. The Retreat will involve yoga classes, travelling to and from India, travelling to various destinations within India, and other activities that may seem mundane but could be risky in India including but not limited to eating, walking around outside of the Retreat Center, interaction with local residents, participating in activities outside of the Retreat Center, inadequate first aid, and hot weather. Potential risks of these activities include but are not limited to: dizziness, fainting, muscle tears, sprains, strains, broken or injured bones, heart attack, food poisoning, contraction of illness, extreme heat or humidity, inappropriate behaviour of other Retreat participants, theft, assault, harassment, motor-vehicle accidents, and airplane accidents, whether or not the injury came as a result of the negligence of yourself, negligence of others, or our negligence. You understand that the risks outlined in this section of the Agreement are risks you will be exposed to during the Retreat and can result in serious bodily and mental harm and a vast array of injuries which could alter your quality of living significantly and may even result in death. Should you have any concerns or doubts about your health or ability to participate in any of the activities in the Retreat, we insist you act prudently and inform us immediately of your concerns. You understand that India can be an extremely dangerous place and that by going there, you are putting yourself in potential danger.

    2.Medical Advice. You acknowledge that you will consult with a physician prior to your departure on the Retreat to ensure that you are aware of any risks of travelling to India and are advised of any recommended pre-trip inoculations. You will also consult with a physician to ensure that your medical and fitness levels are sufficient for you to participate in the Retreat. It is understood between the parties that attendance and participation in the Retreat means you have taken the necessary precautions to ensure that you are healthy enough to do so. 

3. Mandatory Insurance and Travel Preparations. You are required to obtain travel health insurance for the duration of the trip. Other travel insurance is not mandatory, however it is recommended. You are responsible for any medications or services required as a result of illness. You are responsible for making yourself aware of and deciding whether you will obtain any recommended pre-trip inoculations, Visa, passports and any other required travel documents. You are responsible for all additional expenses due to delays, omissions, re-routing, changes in schedule or other events resulting from improper health certificates or travel documents or as an act of any government or authority or any local conditions such as weather, seasonal variation, mechanical problems, labour strikes, civil disturbances, political unrest or natural phenomenon. 

4. Voluntary Assumption of Risk. Having read this Schedule “C” of this Agreement and being fully aware of the risks of participation in the Retreat, your signature at the bottom of the Agreement and this Schedule “C” and your attendance at the Retreat illustrates your voluntary participation and assumption of the risks of the Retreat. You further agree that you have full capacity to agree to the voluntary participation in the Retreat.

5. Commitment to Act Prudently. Understanding that India can be a dangerous place, you are committed to acting prudently and respectfully during your time on the Retreat. You understand that any foolish or provocative behaviour may put you or others into dangerous situations, so you promise avoid such behaviour with best intentions. Ultimately, you are responsible for your own actions which is why you are committed to acting responsibly while on the Retreat. 

6. Release, Waiver, and Indemnity. In consideration of us allowing you to participate in the Retreat and for good and valuable consideration, you hereby release us, our agents, heirs, executors, administrators, successors and assigns from any liability and damages arising from personal injuries or death, however caused including out of negligence, during your participation in the Retreat with us. You understand that you are releasing us at your own risk and that you agree to forfeit any and all forms of legal recourse which may be available to you, including but not limited to any form of damages, as a result of your participation in the Retreat. Further, you agree that these provisions above apply to you, your family, heirs, executors or anyone else who may be able to bring a legal action on your behalf in the future. You hereby indemnify and hold harmless us and our agents, heirs, executors, administrators, successors and assigns from any and all liability for any property damage or personal injury to any third party resulting from your participation in the Retreat.

 

_______________________________ ________________________________

SIGNATURE OF PARTICIPANT              PARTICIPANT NAME (PLEASE PRINT)

 

________________________________ _________________________________

SIGNATURE OF WITNESS                    WITNESS NAME (PLEASE PRINT)

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