Client Registration Form - Shine Retreats

We are so excited to have you join us on Retreat! We want to make sure we have all of your details, wishes and requirements to be sure you are well catered for as well as thoroughly taken care of.

Please fill in the form below. If there is anything else that you wish to tell us please email retreats@shineholistic.co.uk

All of your information is kept safely and just between us.

Tell us about you - Step 1 of 6

Which Retreat are you joining us for?

The Beautiful, Precious ME Retreat
The Creative Writing and Pilates Retreat
The Regeneration Retreat
The On Camera and Audition Ready Retreat
The Tastes + Treats of Tuscany Retreat

Name *

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Occupation

Date of Birth *

In case of emergency contact: *

First

Last

Emergency Contact Phone Number *

Their Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Relationship to you: *

Client Agreement - It is my choice to receive massage therapy and practice Pilates (if applicable) on this retreat. I am aware of the benefits and risks of massage and give my consent for massage. I understand that there is no implied or stated guarantee of success of effectiveness of individual techniques or series of appointments. I acknowledge that massage therapy is not a substitute for medical care, medical examination or diagnosis. I have stated all medical conditions that I am aware of and will inform my practitioner of any changes in my health status. *

I accept the Client Agreement.

Terms & Conditions - By attending this retreat with Shine Retreats, I agree its owners, teachers and any person employed by Shine Retreats are in no way responsible for the safekeeping of my personal belongings. I understand that the Pilates classes (on Creative Writing Retreat) may be physically strenuous, I will be adjusted and massaged, and I voluntarily participate in this with full knowledge that there is risk of personal injury, property loss or death. I agree that neither I, my heirs, assigns or legal representatives will sue or make any other claims of any kind whatsoever against Shine Retreats or its members for any personal injury, property damage/loss, or wrongful death, whether caused by negligence or otherwise. *

I confirm that I have read and accept Shine Retreats Terms and Conditions

Photo Release - Shine Retreats uses images and videos of people on retreat enjoying workshops, talks, meals, and shared events, for website and marketing purposes. Shine Retreats does not identify any person by name unless it has received specific written permission to do so. In consideration of the above, I hereby grant Shine Retreats permission to photograph, film, and make audio and/or video recordings of, me, and to use and display these on Shine Retreats website, archives, and promotional and/or informational material, and in any and all media. I hereby waive and release any right to compensation for, or ownership of, such photograph(s), film(s), and audio and/or video recording(s) of me and the above uses of them by Shine Retreats. *

I confirm that I have read and accept Shine Retreats Photo Release Terms and Conditions

Signature *