Release Form

Life Beyond the Horizon Release Form

Life Beyond the Horizon is a retreat that provides counselling, treatment programs and activities, such as yoga, massage, music and art.

I understand that visiting Life Beyond the Horizon is not a substitute for medical or psychiatric treatment or care. I am responsible for my own medical care, and willingly declare my commitment to completely abstain from alcohol and other chemical use and to respectful, peaceful, non-violent, non-abusive, and non-aggressive behaviour during, and as a condition of, my stay at Life Beyond the Horizon Portugal Retreat.

I further understand that as part of the program I will have opportunity to use all facilities at the retreat and outside the retreat, and to participate in a variety of recreational activities as part of the program, some of which are strenuous and have inherent physical or personal risk.

I acknowledge that to participate in the Life Beyond the Horizon program indicates my acceptance of all risk and that I have no medical reason or advice prohibiting such use or my participation. I understand that my stay at Life Beyond the Horizon and participation in associated activities is an individual choice I freely make at the outset and accept and assume all personal responsibility for my person, health, and property.

I understand that the full payment for my program is required to confirm my place in the program, and, regardless of who funded the monies, is final and non-refundable. Should I not fully complete the program, for any reason, a non-transferable credit for the unused portion of the payment may be applied toward application for a new, full program of equal duration or longer, but not less than the initial one, for me, within one year of departure, subject to policies, room availability and meeting eligibility criteria.

I further understand that my continued stay at Life Beyond the Horizon is contingent upon my demonstrated compliance with the content, spirit and direction from the staff as they apply to all policies, house rules and expectations which I acknowledge I have been given opportunity to review and understand. I understand that behaviour deemed by staff to be non-compliant with staff direction, policies, house rules or expectations may result in early departure from the program.

I understand that my confidentiality will be strictly respected, with information regarding my stay and counselling being released only with my explicit written permission.

PLEASE READ ALL THE DOCUMENTS BELOW:

You are advised to read this Release Form

I thereby confirm I read all the above documents:   YES        NO

To confirm that you have read and accepted the above documents please complete below

Name of person submitting this form:

First______________________Last__________________________

Address:

Street_______________________________ City_________________________

Postal/Zip Code__________________

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Email:_________________________

Phone number, including country code: _____________________

Date ____/______/_______

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