4sretreats23@gmail.com
Home
About
Retreats
Services
Reiki Sessions
Vibrational Sound Therapy
Yoga Sessions
Blog
Gallery
Sign Up
Contact
Book Now
Registration – Books, Beach, Bliss
Contact Info
Name
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
(Required)
Email
(Required)
Emergency Contact Info
Name
(Required)
First
Last
Relationship to you
(Required)
Their Phone
(Required)
Info About Your Stay
Do you have any dietary restrictions/allergies?
(Required)
How do you hope to feel after attending this retreat?
Release of Liability Form
(Required)
I agree to release 4SRetreats
4SRetreats, LLC Liability & Waiver Form By signing below, I acknowledge and agree to the following: 1. I am fully aware that it is my responsibility to consult with a physician before and regarding my participation in any physical activity. I affirm that I am physically fit and have no medical condition that would hinder my full participation in the activities at or with 4SRETREATS, LLC. A licensed physician has thoroughly verified my good health and physical condition so that I can participate in activities offered by 4SRETREATS, LLC. 2. I play a crucial role in maintaining my own safety. It is my duty to recognize and respect my personal limits, and to cease physical activity before it leads to illness or injury. While 4SRETREATS, LLC representatives may offer hands-on assistance and adjustments, I am responsible for clearly communicating if I prefer not to receive such assistance. 3. I fully understand and accept that engaging in practices and activities at or with 4SRETREATS, LLC carries inherent risks. By participating, I acknowledge and agree to assume all risks arising from apparent carelessness, negligence, or gross negligence of 4SRETREATS, LLC, myself, or any other party. I know these activities involve physical exertion, which can be strenuous and may lead to physical injury. 4. I fully understand that Yoga and other offered activities are not substitutes for medical attention, examination, diagnosis, or treatment. 5. I hereby release 4SRETREATS, LLC from any and all liabilities, claims, demands, legal actions, or rights of actions for damages, personal injury, or death in connection with participation in activities with or by 4SRETREATS, LLC. This extends to any and all of the 4SRETREATS, LLC teachers, instructors, affiliates, independent contractors, lease facilities, retreat venues, event venues, and their respective representatives, directors, officers, sponsors, agents, employees/staff, volunteers, contractors, or representatives. 6. I knowingly, voluntarily, and expressly waive all claims I may have against 4SRETREATS, LLC, its owners, sponsors, staff, volunteers, and contractors for any injury or damages that I may sustain as a result of participating in programs or activities offered by 4SRETREATS, LLC. 7. I, my heirs and/or legal representatives, forever release, waive discharge and covenant negligence and/or other acts that may arise against 4SRETREATS, LLC, its owners, directors, officers, sponsors, agents, employees/staff, volunteers, contractors, or representatives. 8. I grant my permission to 4SRETREATS, LLC and any transferee or licensee of them to utilize any photographs, motion pictures, video, recordings, and other references or records of activities with and at 4SRETREATS, LLC that may depict, record, or refer to me for any purpose (“likeness”), including commercial use by the released parties, their sponsors and their licensees. 9. All payments are non-refundable and non-transferable for any reason, including but not limited to extenuating circumstances, illness, and injury. The scheduling and content of activities are subject to change as necessitated by schedule and availability based on the mandate of owners, management, and contractors of 4SRETREATS, LLC. I have fully read and understood the above release and waiver of liability. I fully understand its contents and that by signing it, I am obligated to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. By signing this agreement, I am waiving certain legal rights I or my heirs, next of kin, executors, administrators, and assigns may have against 4SRETREATS, LLC or its owners. I am signing this agreement voluntarily and recognize that my signature serves as a complete and unconditional release of all liability to the greatest extent allowed by law in Florida. Signing also provides consent for 4SRETREATS, LLC to email me with reminders and offers.
Signature
Date
Payment Information
This field is hidden when viewing the form
Are You a Local?
Yes, I am a local and will not need accommodations ($500)
No, I will need accommodations
Retreat Payment
(Required)
I have read the refund policy in the FAQ, agree to, and understand that portions of my payment may be non-refundable.
Price
(Required)
Twin bed in shared room and shared bath
Deposit
This field is hidden when viewing the form
Price
(Required)
First Choice
Second Choice
$1500 Or $500 Deposit
Coupon
Total Due Today
Credit Card
Untitled
Untitled
Phone
This field is for validation purposes and should be left unchanged.
Menu
Sign Up For Updates!
Name
(Required)
Email
(Required)
Comments
This field is for validation purposes and should be left unchanged.
CLOSE