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Essence of Love by Turiya Hanover
  

Booking Form

Each person needs to fill out this form and complete all sections before payment is made on the following page.
The information below will be kept strictly confidential.

*Indicates required fields.
 
*FIRST NAME: (legal) MIDDLE NAME:
*LAST NAME: (legal) OTHER NAME:
*SEX FEMALE MALE *OCCUPATION:
*EMAIL *DATE OF BIRTH: DD/MM/YYYY
*ADDRESS 1 ADDRESS 2
*CITY *STATE/PROVENCE
*ZIP/POSTAL *COUNTRY
*TELEPHONE MOBILE
FAX How did you hear about us?
IF YOU HAVE A SPOUSE, PARTNER OR FAMILY MEMBER PARTICIPATING IN THE SAME WORKSHOP, PLEASE GIVE THE FOLLOWING INFORMATION:
FIRST NAME: MIDDLE NAME:
LAST NAME: OTHER NAME:
*1. What groups and workshops have you done before?
*2. Have you ever attended any Enneagram workshops before?
*3. Do you have any particular food or environment allergies?
*4. Do you have any physical health problems such as diabetes, asthma, high blood pressure, hepatitis, epilepsy, heart diseases, etc.? Is there anything we can do to make your stay comfortable? 
The following questions below may seem personal but they are intended to better assist Turiya in guiding you through the workshop. All responses will be held in strict confidence.
*5. Are you currently under a doctor's care and or taking prescription medications? If so, specify the condition and the medication.
*6.  Are you in need of or currently taking anti-depressants, mood altering drugs, or herbal remedies, or tranquilizers?
*7. Are you consuming or using drugs such as amphetamines, diet pills, narcotics, cocaine, barbiturates, marijuana, heroine, etc.? It so, please give details such as quantities and frequency of consumption.

*8. Do you have any physical handicaps? If Yes, which? 
*9. Have you ever been in psychiatric treatment? If yes, when and what was the diagnosis?
*10. Please describe briefly your experience with groups and therapy
*15. Are you pregnant? YES NO UNSURE
*LEGAL SIGNATURE: *DATE:
By signing and dating the above form, I agree that all statements are true to the best of my knowledge. Essence Workshop with Turiya Hanover



Please proceed to Terms & Conditions...
 
Terms & Conditions for all Participants

1. Meditation and Therapy

I declare that I am taking part in the workshop offered, of my own free will and on my own responsibility. I am aware that the workshop does not offer medical help in the classical sense. The workshop is designed to give the participant a framework for personal growth. I agree to follow the rules and instructions of the workshop.

2. Health check, Medical costs, Medical confidentiality

I hereby declare that I am not suffering from any medical of physical illness that could put me, or another participant during the retreat in any way in danger. Also, I consent to having a consultation talk with the Turiya, or her organiser, if it deems necessary. Turiya and her organiser rely on the accuracy and completeness of the information I have given about my physical and mental condition as well as my medical and psychiatric case history.

I am obliged to immediately inform Turiya, or her organiser, of any changes in my health condition, which might in my best estimation bring into question my further participation in the workshop. I am obliged to inform Turiya, or her organiser, of any medication I am currently taking or take on a regular basis.

3. Release from Liability

I agree to I release Turiya, organiser and assistants (if applicable) all third parties claims of material or intangible form for this workshop.

4. Alcohol & Drugs

The use of alcohol & drugs or any mood altering substances (hallucinogenic, tranquilizers, etc.) are not allowed during this workshop.

5. Confidentiality

To protect the identity and privacy of all participants I agree to not make any photographs or sound recordings without first obtaining the agreement of Turiya and/or the workshop participants. To protect the privacy of all participants I agree to maintain confidentiality about the process and information I come to know in this workshop, regardless of whether this relates to the Turiya, organiser, assistance and participants. I will respect the identity and privacy of all individuals attending this workshop.

6. Cancellation and premature termination of contract

Turiya has the right, at any time, either before or during the workshop, to expel or debar a participant, without having to give any reason for doing so. The participation fee will be refunded on a pro rata basis. If the underlying reason for the expulsion is a breach of the instructions and rules set forth by Turiya, or the organiser, there is no right for repayment or participation fee. If the expulsion takes place during the workshop the participant will be notified and instructs of the impending expulsion.

In case of cancellation from the side of the participants the signed Booking and Cancellation Policy is validating.

7. Declaration of consent
*LEGAL SIGNATURE: *DATE:
By signing the above, I declare that I have carefully and thoroughly read the above terms & conditions and agree to them.

 

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