Name *

First Name

Last Name

Phone

(###)

###

####

I acknowledge that my participation in the INTRA retreat is entirely at my own risk and that the facilitators and hosting entity are not liable for any injury or adverse outcome. I understand that I am free to go at my own pace, and participation in each activity is my personal choice, without fault or obligation. *

Yes

I will take my own precautions to guard my own safety and wellness throughout INTRA. *

Yes