Health Questionnaire & Participant Agreement
RIMA Journey - January 20/23 - 2022
Health Questionnaire
Name
Emergency Contact
Emergency contact phone
We offer a vegetarian diet while on retreat. Do you have a severe food allergy, any sensitivities, or a medically diagnosed intolerance of any kind?
Are you currently taking any medicines or receiving any medical treatment? Can you share with us any health concerns that may be relevant?
Is there anything else we need to know in order to look after you for this experience?

Participant Agreement


In consideration of my participation in a retreat jointly organized by Rima and associated events and Activities (collectively referred to as “Retreat”) and the services Rima its agents, owners, officers, volunteers, participants, employees, sponsors, and all other persons or entities acting in any capacity on its behalf, as well as its successor and assigns (collectively referred to as “Rima”), I, on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate (collectively referred to as “Participant”), hereby agree to release and discharge Rima as follows:

1. Waiver of Liability and Release. Participant does hereby release and forever discharge Rima from any and all liability, claims, and causes in action, which arise or may hereafter arise or are in any way connected to Participant’s involvement in a Retreat. Participant understands that this agreement discharges Rima from any liability or claim that the Participant may have against Rima with respect to any bodily injury, personal injury, illness, death, or property damage that may result from Participant’s involvement in a Retreat, whether caused by the negligence of Rima, or otherwise. Participant also understands that Rima does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health, or disability insurance in the event of injury or illness.

Participant understands and acknowledges that the Activities in which Participant will voluntarily engage in at a Retreat bear certain known inherent Risks that contribute to the unique character of these Activities, and that Rima cannot eliminate, alter, or control these inherent risks. These Risks include those inherent in yoga activities, body activities, as well as those inherent in backcountry recreational activities.

2. Indemnification and Hold Harmless. Participant hereby agrees to indemnify and hold harmless Rima from any liability, claims, and causes in action, which are in any way connected to Participant’s involvement in a Retreat, or use of Rima facilities or equipment, including any such claims which allege negligent acts or omissions of Rima.

3. Medical Care. Participant does hereby release and forever discharge Rima from any liability, claims, and causes in action that arise or may hereafter arise on account of any first aid, treatment, or service rendered or not rendered in connection with the Participant’s involvement in a Retreat.

4. Certification and Assumption of Risk. Participant here-by certifies that he/she is physically fit, has trained sufficiently for participation in the Retreat and has not been advised otherwise by a qualified medical person. Participant agrees that Rima is not qualified to evaluate Participant or Participant’s fitness for involvement in the Retreat. Participant must determine if he or she is sufficiently fit to participate. Participant hereby expressly and specifically assumes the risk of injury or harm in the Participant’s involvement in the Retreat, including, but not limited to all Risks. Participant agrees that his/her involvement in the Retreat is purely voluntary, and Participant elects to participate in the Retreat in spite of the Risks.

5. Definitions. “Activities” include, but are not limited to the workshops and which may be provided and/or sponsored by Rima in the course of the Retreat and which descriptions will be provided to the participant at the beginning the retreat.

6. Personal Property. Participant acknowledges and agrees that he/she is responsible for his/her equipment and all personal property during the Retreat and that Rima is not responsible in any way for such property whether it is lost, stolen or damaged.

7. Photographic Release. Participant does hereby grant and convey unto Rima all right, title and interest in any and all photographic images, video or audio recordings made by Rima during the Retreat. Participant authorizes Rima to use such images, words, and likenesses for internal purposes and Social Media applications.

8. Interpretation and Governing Law. This document shall be construed broadly to provide a release and waiver to the maximum extent permitted under Portuguese law. If any portion of this document shall be held as invalid it is agreed that the balance shall continue to be in full force and effect. This document shall be governed by the laws of Portugal. Venue for any legal action shall be in the state or federal courts of Portugal as applicable.
Name (acting as e-signature)
Email
Date