Bliss Out Retreat Atteendee Form – Ananda Wellness Yoga

Bliss Out Yoga & Wellness Retreat 2025

Are you ready for serenity, peace and to recharge under the African skies? This retreat isn’t called Bliss Out for nothing!

As with any retreat / event there are some nitty gritty details and important information we require to make your time at the retreat as pleasurable as possible and in case of any emergency. Getting this out of the way allows the retreat to flow with ease.

Please read and complete all the information below as honestly and accurately as possible and be sure to press the send button at the end to submit your form.

Full Names & Surname

Physical Address

Date of Birth: (please give the correct info here)

Email Address:

Cell Phone or WhatsApp Number:

Any Dietary Restrictions / Allergies (please specify clearly):

Please specify and explain any injuries or physical conditions you may have and include if you are receiving treatment from your Medical Practitioner:

Emergency Contact Name and Cellphone Number: (Spouse or Relative)

Medical Practitioner / Doctor Name and Telephone Number:

Are you pregnant?

Yes No

If you are pregnant, please indicate how many months

Any other requests or comments:

Registration and Agreement of Release and Waiver of Liability Form
Bliss Out in the Wild Yoga & Wellness Retreat – 24 to 27 October 2025
By completing, signing and answering this form, I hereby agree to the following:
1. That I am participating in a Yoga Class, Workshop, or Pre-registered yoga event/retreat offered by Ananda Wellness, Ananda Wellness Getaways during which I will receive information / instruction about Yoga, Meditation, Breathwork, Holistic Wellness, Sound Healing, Nature Walks, TRE (tension, stress, Trauma release). I recognize that Yoga and some of the retreat activities listed on the itinerary may require some physical exertion, which may be strenuous and may cause physical injury. I am fully aware of the risks and/or hazards involved.
2. I understand that it is my responsibility to consult a physician prior to and regarding my participation in the Yoga Class, Workshop, or Pre-registered yoga event/retreat, along with all the itinerary activities. I certify that I am physically fit, and I have no medical condition, which would prevent my full participation in the Yoga Class, Workshop or Pre-registered yoga event/retreat, along with the itinerary activities.
3. I agree to assume full responsibility for any risks, injuries or damages, known or unknown, which I incur as a result of participating in any yoga program/ event/retreat and all activities hosted by or at Ananda Wellness & Ananda Wellness Getaways, including hot or warm temperature activities and yoga.
4. I knowingly, voluntarily and expressly waive any claim that I may have against Ananda Wellness, Ananda Wellness Getaways, its directors, instructors, staff, owners and family, for any injury, death or damages that I may sustain as a result of being in any facility indoors or outdoors where Ananda Wellness & Ananda Wellness Getaways provides classes or as a result of participating in a Yoga class, Workshop or Pre-registered yoga event/retreat and all itinerary activities; including loss that may be caused by negligence of the release party.
5. I release and discharge Ananda Wellness & Ananda Wellness Getaways, its directors, owners, staff, family and its instructors from any and all liability, claim, demand or action that I may have related to the loss, theft or damage of any personal property while participating at any facility, venue / studio or outdoors where Ananda Wellness & Ananda Wellness Getaways is hosting/ facilitating / instructing a Yoga Class, Workshop, or Pre-registered yoga event/retreat in person and online.
7. I give consent that personal information may be passed to referring doctors and other professional persons concerned.
8. I realize that hands on physical adjustments may take place during a class, workshop, event/retreat by means of physical touch and contact and I agree and consent hereto.
9. I consent to photographic pictures/videos being taken of me during any Yoga Class, Workshop or Pre-registered Yoga event/retreat in person and online and I give permission for these photographic pictures/videos to be used on any of Ananda Wellness & Ananda Wellness Getaways or affiliated social media accounts and platforms including prints and or other media related to when required. In non-agreement of this please kindly send us an email to info@anandawellnessbliss.com and we will ensure your privacy is kept confidential by means of blurring out or removing your image where possible.
10. I, my heirs or legal representatives, forever release, waive, discharge and covenant negligence or other acts.
I have read the above registration, release and waiver of liability and fully understand its contents. I am 18 years of age and older and voluntarily agree and consent to the terms and conditions stated above.
I have read the foregoing and fully understand the contents thereof. This Agreement, Authorization and Release shall be binding upon me, my heirs, legal representatives, and assigns.
By completing and signing this form online by means of digital Name & Surname entered below and sending it back, you acknowledge having read it and agree to and confirm all the content and information provided.

Please take the time to also read Ananda Wellness Refund & Cancellation Policy.

Bliss Out Yoga & Wellness Retreat 2025

Are you ready for serenity, peace and to recharge under the African skies? This retreat isn’t called Bliss Out for nothing!

Please read and complete all the information below as honestly and accurately as possible and be sure to press the send button at the end to submit your form.

Let's chat

Bliss Members

Quick Links