Client Wellness Form

Before your wellness journey begins with Silver Linings Retreats, we ask that you kindly complete and acknowledge the following form and waiver.

All personal details are confidential and will only be used internally to inform the relevant SLR instructor or wellness consultant.

PERSONAL DETAILS
NAME *
NAME
GENDER *
ADDRESS *
ADDRESS
DATE OF BIRTH *
DATE OF BIRTH
Signature retreat guests only
EMERGENCY CONTACT DETAILS
KEY WELLNESS QUESTIONS
The following questions are designed to give us a ‘snapshot’ of your current wellness, any areas of concern and your goals. For all the questions below: 1 = poor and 10 = fantastic.
How do you feel about your wellness overall? *
Movement *
How would you describe your current fitness levels?
Rest & Relaxation *
Do you regularly find time to relax/meditate/enjoy some ‘me time’?
Sleep *
How would you rate your quality of sleep?
Nutrition *
How would you rate your current dietary habits?
Are you:
Have you been given permission by your GP/Surgeon/Physiotherapist to resume training?
Are you Pre or Postnatal? *
Have you been given permission by your GP/Obstetrician to exercise?
YOUR RETREAT GOALS
What are your personal retreat goals?
Tick multiple if you wish

LIABILITY WAIVER
I acknowledge that the activities and services provided by Silver Linings Retreats, a UK Limited Company (company number 10205595) involve physical exercise and/or dietary modifications that can be strenuous and may cause bodily injury. I understand that there is an inherent risk of bodily injury when choosing to participate in any physical exercise, sport, wellness, nutritional and/or recreational activities, including services. My participation in the services is a voluntary activity in all respects and I assume all risks of bodily injury and illness that may result from the services. In consideration of Silver Linings Retreats, and all other persons acting in any capacity on behalf of Silver Linings Retreats in providing the services, along with the owner or owners of the premises in which the services are provided, their respective insurers, heirs, personal representatives, successors and assigns, (collectively, the “Released Parties”), I hereby waive, to the fullest extent permitted by law and on behalf of myself, my children*, my heirs, my assigns, personal representatives and all other persons acting on my behalf, the right to bring any suit, action or claim of any kind against any Released Party as a result of my participation in the services and hereby release and discharge, to the fullest extent permitted by law and on behalf of myself, my children, my heirs, my assigns, personal representatives and all other person acting on my behalf, the Released Parties, in any capacity, as follows: from any and all liability, claims and causes of action of any nature whatsoever arising from bodily injuries or illness (including emotional and psychological injuries or illness, and death), and damages (both economic and non-economic) or losses of any kind which I may have or which may accrue to me on account of my participation in the services, regardless of whether such injuries result, in whole or in part, from the negligence of any Released party. *All childcare (including all childcare activities) on retreat is fully managed by the hotel and Silver Linings Retreats accepts no liability for any of these activities. I further agree to indemnify and hold harmless and defend the Released Parties from any and all liabilities, claims and causes of action of any nature whatsoever resulting from injuries or illness, damages (both economic and non-economic) or loss, including attorney fees, sustained by me arising out of or in connection with or in any way associated with my participation in the services or resulting from my breach of any of the terms of this document. I acknowledge that I have been advised to consult with my physician before I undertake any physical activity or nutritional or exercise program, including the services. I certify that I am in good health and sufficient physical condition to participate in the Services. I further acknowledge that the Released parties are neither responsible for nor liable for any loss of or theft of any personal property brought by me or left by me at any service provided by Silver Linings Retreats and I hereby release the Released Parties from any liability for such loss or theft. I acknowledge that none of the Released Parties has represented to me or provided me with any assurance of any kind that my participation in the services will result in any particular physical, psychological or other outcome, such as weight loss, psychotherapeutic benefits or the ability to perform any sport or other physical activity. I agree that I will not copy, photograph, broadcast, retransmit or otherwise record in any manner any portion of any service or any written or other tangible materials used in connection with any service and that my participation in the services is solely for my own personal use and not for use by any other person or for any commercial purpose whatsoever. I acknowledge that I have read and fully understand this Waiver of Liability and Release as set forth above and that I am signing it voluntarily with full knowledge of its contents.
Please confirm that you have understood and agree with the Liability Waiver *
DATE *
DATE