First Name *

Last Name *

Date of Birth

Email (will be kept confidential) *

Phone *

Address *

Address

City

State/Province

Zip/Postal

Country

Describe any injuries/conditions you might have (if none, type “none”)

Final Payment will be made via

Check

Venmo

Online payment w/credit card (via PayPal)

Cash

Retreat Questionnairre

1.) How are you feeling about attending this Retreat? Do you have any concerns or desires that you would like to let me know ahead of time? *

2.) Most of the meals will be provided. You will be having a few dinners on your own. All food will be organic when possible, with GF as a standard, mostly plant based meals with animal protein here and there. If you have any food restrictions or allergies, please list them here so we can take care of you. *

3.) In our effort to keep you safe, relaxed and enjoying the most from the movement and nature retreat, are there any other medical conditions that we should know about? *

Emergency Contact for the SOMA Retreat

Primary Emergency Contact *

First Name

Last Name *

Last Name

Relationship to you *

Relationship to you

Primary Care Physician *

Physician’s Phone Number

Agreement of Release and Waiver of Liability

Read the following carefully:

I understand that I am participating in the SOMA Retreat offered by Wendy Elliott and The Blue Zone Retreat, during which I will receive information and instruction about movement, nature, and health. I recognize that a movement practice and hiking in nature requires physical exertion that may cause physical injury, and I am fully aware of the risks and hazards involved.

I understand that it is my responsibility to consult with a physician prior to and regarding my participation in the Soma Retreat. I represent and warrant that I am physically fit and I have no medical conditions that would prevent my full participation in the Soma Retreat.

I understand that if I am pregnant, I will take necessary steps to ensure my doctor and health care providers know I am participating in this Soma Retreat. I assert that I am of fit health to participate in the Soma Retreat and will alert Wendy Elliott whose sessions I participate in that I am pregnant.

In consideration of being permitted to participate in the Soma Retreat, I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I might incur as a result of participating in the retreat, including any and all activities done with the Soma Retreat group, or as an individual at The Blue Zone Retreat in Tambor, Costa Rica.

In further consideration of being permitted to participate in the Soma Retreat, I knowingly, voluntarily and expressly waive any claim I may have against We Mind Body Spirit and Wendy Elliott, its staff, Tara Elliott and The Blue Zone Retreat and its staff for injury or damages that I may sustain as a result of participating in the retreat. I, my heirs and legal representatives forever release, waive, discharge and covenant not to sue Wendy Elliott, Tara Elliott and The Blue Zone Retreat and its staff for any injury or death caused by their negligence or other acts.

CANCELLATION POLICY – I understand that if I need to cancel my participation in the Soma Retreat that I will not receive a refund. Should the Soma Retreat event be canceled by Wendy Elliott or The Blue Zone Retreat, all fees will be refunded back to participant.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree and confirm being invited to consult legal counsel before signing below.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree and confirm being invited to consult legal counsel before signing below.

Yes, I agree.

SOMA – COVID-19 Guidelines and Cancellation Policy

Read the following carefully:

COVID-19 safety measures require us to continue to adapt our hospitality — but, our dedication to exploring embodied healing practices remains the same. Here are the ways we will continue to keep you safe at the Soma Retreat considering new information about the highly contagious Delta variant and updated guidance from the CDC.

All guests will be required to provide proof of vaccination to register for the Soma Retreat. Except for your room, all other spaces at the Blue Zone Retreat are open aired including the yoga studio and dining areas. Guests will be encouraged to mask up if they are in an enclosed area. Upon arrival, guests will be asked a series of health questions and to sign a waiver at check-in.

As of April 1, 2022, the United States requires all visitors to Costa Rica to have a negative COVID-19 before flying back to the States. 

The International Airport in San Jose has a rapid COVID-19 test site, so most visitors give themselves enough time at the airport to get tested before boarding the plane back home. The cost for the COVID-19 test is $60.00

Because the situation continues to change and we can not predict what will be happening in February 2023, if the Soma Retreat needs to be canceled because either Costa Rica or the USA changes the rules due to COVID-19, then participants will receive a full refund including all deposits.

If a guest chooses to cancel because of personal reasons, deposits and payments will not be refunded.

I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree and confirm being invited to consult legal counsel before signing below.

Yes, I agree.

Type your full name (online signature)

Proof of Vaccination

Please upload a photo of your vaccination (jpg, gif or png – 15MB max)

Maximum file size: 15MB

Optional Activities

Please check all activities you’re interested in and include all fees in your final payment.

Bio Luminescent Tour (Thursday evening) $50.00

Hike in Curu Wildlife Refuge $40

Birding Exploration $20

Final Payment, including Optional Activity Fees, Due January 15, 2023
Please mark your calendar and bookmark the link below so you can make your final payment on or before January 15, 2023.

Your final payment can be made here: www.somaticwendyelliott.com/2023-retreat-fianl-payment
PLEASE NOTE: this link will also appear in your registration confirmation email.

First Payment / Deposit

First Payment due on or before 12/01/22 / Final Payment due on or before 01/15/23

Select your desired payment option: *

Single Occupancy with AC ($1995) – 50% DEPOSIT $997.50

Double Occupancy with AC ($1795)- 50% DEPOSIT $897.50

Double Occupancy no AC ($1695) – 50% DEPOSIT $847.50

To enjoy Single Occupancy in either of the Double Rooms listed above add $500

Upgrade me to a Single Occupancy in a Double Room for an extra $500.00

No thank you!

TOTAL DEPOSIT:

If you are human, leave this field blank.

REGISTRATION

SOMA: Movement and Nature Retreat at the Blue Zone Retreat, Tambor, Costa Rica