Retreat Waiver Form — Healing Art With Panna Vekaria

Retreat Waiver Form

I agree to the retreat waiver, the above terms and conditions and the terms and conditions page on the www.pannavekaria.art website.

Name

First Name

Last Name

Email

Date

MM

DD

YYYY

Emergency Contact 1

First Name

Last Name

Relationship

Phone

Country

(###)

###

####

Emergency Contact 2

First Name

Last Name

Relationship

Phone

Country

(###)

###

####