Embodying LIGHT: Professional Development in Somatic Grief Practices

Embodying LIGHT: Professional Development in Somatic Grief Practices - Registration

December 5-9 for Continuing Education, plus December 10 for Yoga Teacher Training
Important Instructions

This registration is for the weekend retreat with professional development. This registration is for those who are seeking continuing education credits and/or yoga teacher training. If you would like to attend only the weekend retreat as a participant only, please return to www.laforet.org/events and click on the event titled "Embodying LIGHT Retreat"

Please note that input boxes ith an asterisk (*) are required, while other fields are optional.

At the bottom of each page is a "save" buton which allows you to save your progress and come back later. Please note that if you select this option the system will require you to enter an email and password so you can log back in later.

If someone other than you will be completing the payment, or if there is any other reason you need to pay later, you will have that option on the last page.

If you have any questions, feel free to contact us at camp@laforet.org or 719-822-7243.
Name*

First NameLast Name
Email (required for confirmation and event communication)*
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Phone Number*
Please enter a valid phone number.
Do you have a preferred name or nickname?
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Authorizations and Medical Information
Emergency Contact
Emergency Contact's Name*

First NameLast Name
Emergency Contact's Phone Number*
Please enter a valid phone number.
Emergency Contact's Email
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Alternate Emergency Contact's Name (Optional)

First NameLast Name
Alternate Emergency Contact's Phone Number
Please enter a valid phone number.
Alternate Emergency Contact's Email
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Medical Information

Optional, but helpful
Is there any medication you take that you would like us to be aware of in case of emergency?
Consider listing medications whose absence / dosage / or impact when paired with additional factors (food, altitude, etc.) can adversely and rapidly affect your health.
Do you have any concerns about your ability to participate fully at this event?
If so, please list these concerns here so we can address them if possible / necessary.
Do you have any other accessibility needs or mobility challenges?
Accessibility needs may be things like needing extra time in between activities to get from one location to another, trouble navigating camp terrain, stairs, etc.
Do you have any allergies that you would like us to be aware of?
Especially environmental or dietary.
Authorization for Emergency Medical Treatment

I hereby give my permission to Rocky Mountain Conference, La Foret staff (if applicable) and program staff to call a doctor or emergency medical service and for the doctor, hospital, or medical service to provide emergency medical or surgical treatment for myself should an emergency arise. It is understood that La Foret and program staff will make a conscientious effort to locate the emergency contacts listed before any action is taken. If such contacts cannot be made, I authorize La Foret and program staff to administer care they deem necessary. I hereby accept full financial responsibility for the payment of all expenses related to such emergency medical treatment.
I grant my permission for emergency medical treatment. Signature:*

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Name*

First NameLast Name
Date of Signature*

MonthDayYear
Date
Hour MinutesAM/PM Option

Dietary Requests - Optional

If you are staying on site and eating in our dining hall, please specify if you have any dietary REQUIREMENTS. Cost is $40.90 per day for three meals. There is an option for those staying offsite to instead just purchase lunches and dinners for $30.60 a day. A salad bar with fresh produce and diverse options is available at every meal.
Dietary Requirements

VegetarianVeganDairy FreeGluten Free (some gluten contamination is possible. We cannot accommodate celiac requirements)Nut Allergy (please specify below)Other (please specify below)
Additional Comments on Above Selection
Optional: IF you have an airbourne allergy, please list it here
Optional: If you have a different dietary restriction, please list here
Please note that we cannot accommodate certain diets or preferences. There is a salad bar at every meal that allows for a wide variety of dietary preferences to be met. If you have an extremely restrictive diet, you may wish to bring your own food. In this case we will work with you individually to create a discount and food storage plan for you.

Photo/Video Release

I understand that photographs may be taken of myself or my child during events sponsored in whole or in part by La Foret Conference and Retreat Center. I understand that some of these photos may be reproduced and/or used in printed materials, promotional materials, and on websites that are the property of La Foret Conference and Retreat Center. I am aware that photos of minors never include any identifying information about those pictured. I understand that any photos or video taken during La Foret events will never be sold, used for profit, or given to a third party. I am aware that I will receive no compensation for the use of these photos. I further understand that if I do not give my consent, I may still be photographed/filmed, but that any photo/video of me will not be used or shared.
I have read and understand La Foret's Photo/Video Release policy. I grant permission to La Foret Conference and Retreat Center to use photographs and video footage of myself /my child in various promotional projects.

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Name

First NameLast Name
Date

MonthDayYear
Date
Hour MinutesAM/PM Option

Assumption of Risks and Release of Liability
Acknowledgement of Risks

In consideration of my own participation in activities sponsored by La Foret Conference and Retreat Center:

I understand that there are numerous risks associated with participation in any outdoor activities, including such risks as hiking, swimming, backpacking, out-camping, wildlife interactions, ropes courses, field games, crafts, and transportation to and from camp activities, and that many, but not all, of these risks are inherent in these and other activities. These risks, which contribute to the unique character and desirability of the activities involved, may pose the possibility of severe injury, illness, or death. I further understand that most of the activities involved in the program experience at La Foret will take place in an outdoor environment, and that La Foret staff have taken all reasonable measures to insure the safety and well being of all participants, including, but not limited to:
- insuring that any instructors for activities offered at La Foret meet all the regulatory requirements (local, state, federal) for that position or activity.
- insuring that all obvious and known hazards have been removed from the actual program area and frequented grounds.
I also understand that many of the risks inherent in the program experience cannot be eliminated, altered or controlled. Some, but not all, of the specific risks include:
- Weather conditions may change rapidly and unpredictably and may directly cause injury. Severe weather such as thunderstorms, hail storms, lightning strikes, burning sun, cold temperatures, forest fires, tornadoes, and others may also affect participant safety through the secondary impact of power outages, impaired equipment, and structural damage.
- Equipment used in activities may break, fail or malfunction, despite reasonable maintenance and use, and may inflict injuries, even when used as intended. Persons using equipment may lose control of such equipment and cause injury to themselves and/or others.
- Most activities take place in a natural environment where unexpected, unseen, unknown, and/or unmarked objects and conditions create risk of injury, i.e. tripping, falling, slipping, insect bites, animal contact, unstable surface conditions, falling rocks and objects, potentially harmful vegetation, etc.
Facilitators use their best judgment in determining participant's ability to participate in camp activities. However, participants may have unknown conditions which would limit their participation in certain activities or increase participant's risk of injury. It is imperative that participants and/or parents notify the event staff, in writing via this registration process, of any known limitations.

Motor and vehicle accidents, not the direct fault of facilitators and La Foret staff, may occur in the course of transporting participants to and from other activities.

Some activities may have inherent risks, due to the nature of the experience, and there may be other risks which cannot be anticipated.
I acknowledge and assume all risks involved in participation in any of these activities and for any damage, illness, injury, or death resulting from such risks, for myself. There are no physical, emotional, or mental problems or limitations associated with my participation in activities, except as disclosed by me in writing on the Medical pages of this registration. (Please note we cannot accept your registration without your agreement to this release. Please contact camp@laforet.org with any questions)*

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Name*

First NameLast Name
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option
Release, Waiver of Liability, and Indemnification

I do understand and accept the risks of participation and do hereby release and waive any claim of liability against La Foret Conference and Retreat Center and its employees and agents with respect to any injury, illness, damage or death, occurring to me while participating in any and all camp/retreat programs and activities.

Governing Law

I agree that this form, and all other aspects of my relationship with La Foret Conference and Retreat Center and its agents and employees, shall be governed by the laws of the State of Colorado. Further, I agree that any legal proceedings concerning such relationship shall be filed exclusively in the State of Colorado.
I have read and understand the above and agree to be bound by the terms of this document. (Please note we cannot accept your registration without your agreement to this release. Please contact camp@laforet.org with any questions)*

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Name*

First NameLast Name
Date*

MonthDayYear
Date
Hour MinutesAM/PM Option

Embodying LIGHT: Professional Development in Somatic Grief Practices - Registration

Authorizations and Medical Information

Emergency Contact

Medical Information

Authorization for Emergency Medical Treatment

Dietary Requests - Optional

Photo/Video Release

Assumption of Risks and Release of Liability

Attendance and Lodging

Credit Card

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