Name of Retreat you are booking for	Date of Retreat you are booking for
First name:	Last name:
Sex:Female Male	Ocupation:
Date of birth - day/month/year	Country of birth:
Complete Address incl. City & State/Province:	Country of residency:
Telephone:	Mobile:
Email Address:	If you have a spouse, partner or family member parcipitating in the course, please give details:
What is it in life that you seek?	How is your life at the moment? (write a short summary)
What are you expecting from this retreat?	Do you have any food or environment allergies?
Please briefly describe your Yoga asanas practice experience.	Please briefly describe your meditation practice experience.
Are you currently under doctor's care and/or taking prescription medications? If so, please specify both the condition and medication. Are you currently taking anti-depresants, mood altering drugs, or herbal remedies or tranquilisers?	Do you have any physical health problems such as diabetes, asthma, high blood pressure, hepatitis, epilepsy, heart diseases, etc?
Are you consuming or using drugs such as amphetamines, diet pills, narcotics, cocaine, barbituates, marijuana, heroine etc? If so, please give details such as quantities and frequency of consumption	Have you ever been in psychiatric treatment? If yes, when and what was the diagnosis?
Please briefly describe your experience with yoga workshops or group therapy and meditation.	Would you like private Self Understanding sessions with Kali? Yes No How many sessions would you like? Sessions cost Euros 80
Legal Signature:	Date:

By signing and dating the above form, I agree that all statements are true to the best of my knowledge.

Conditions and Obligations of Participants

1. Yoga, Meditation, Self-Understanding and Silence

I declare that I am taking part at the offered retreat, of my own free will and on my own responsibility. I am aware that the retreat does not offer medical help in the classical sense. The group give the participant a framework for personal growth. I agree to follow the rules and instructions necessary for this.

2. Health check, Medical costs, Medical confidentiality

I hereby declare that I am not suffering from any medical of physical illness that could put me, or another participant during the retreat in any way in danger. Also, I consent to having a consultation or clarifying talk with the retreat facilitators, or Yossum staff if seems it is necessary. The organization of the Yossum Retreat can rely on the accuracy and completeness of the information I have given about my physical and mental condition as well as my medical and psychiatric case history.

I am obliged to immediately inform the staff of the Yossum Retreat of any changes in my health, which might in my estimation bring into question my further participation in the event. I am obliged to inform the Yossum Retreat facilitators of any medicament I am currently taking or take on a regular basis.

3. Release from Liability

With reference to paragraph 1 of this agreement I release Yossum, the responsible retreats facilitators and assistants, likewise all third parties claims of a material or intangible form.

4. Drugs

The use of drugs or mood altering substances (hallucinogenic, tranquilizers, etc.) are not allowed.

5. Confidentiality

To protect the identity and privacy of all participants I agree to not make any photographs or sound recordings without first obtaining the agreement of the retreat facilitators and all the group participants of the Yossum Retreat. To protect the privacy of all participants I agree to maintain confidentiality about the process and information I come to know in this retreat, regardless of whether this relates to the group participants, group leader or assistants. I will respect the identity and privacy of other people.

6. Cancellation and premature termination of contract

The Yossum organization has the right, at any time, either before or during the retreat, to expel or debar a participant, without having to give any reason for doing so. The participation fee will be refunded on a pro rata basis. If the underlying reason for the expulsion is a breach of the instructions and rules of the Yossum Retreat or a person representing Yossum, there is no right for repayment or participation fee. If the expulsion takes place after the beginning of the retreat the participant will be regularly warned before and instructs of the impending expulsion.

In case of cancellation from the side of the participants the signed Booking and Cancellation Policy is validating.

7. Declaration of consent

By signing and dating the above form, I agree that all statements are true to the best of my knowledge.