Client Waiver Form
All clients are required to agree to the following Release and Liability Waiver which is effective for all Retreats and Sessions.
By signing below, I acknowledge and agree that:
( ) Practitioners at Vita wellness do not diagnose conditions, prescribe medications, or provide medical treatments
( ) The sole purpose of the sessions or Retreats are to assist in balancing, harmonizing, releasing, and healing on all four levels (physical, mental, emotional, and spiritual)
( ) I assume sole responsibility for my own health and for the results of any sessions or Retreats provided by Vita wellness that may affect my health in any way
( ) Treatments will not replace conventional medical diagnosis or treatment. I will continue taking medication prescribed by a licensed medical physician and will continue to follow his/her instructions
( ) I release Vita wellness, its owners, and practitioners from all legal liability during my participation in treatments
( ) All information received by me from Vita wellness practitioners is accepted with full knowledge that any action taken by me as a result of the information received is my complete responsibility
( ) If any disruptive, inappropriate, or mentally unwell behavior is displayed to the staff or other clients, to the point the retreat staff and coach cannot or is not qualified to contain, you may be released and asked to leave from the program and referred to another facility or professional. Without repercussions towards Vita wellness or refunds of any kind.
( ) I understand that if I bring/consume any alcohol or drugs during my stay I can be asked to leave early without any refunds.
( ) I understand that unless I have pre-written consent and approval I may not have visitors during my stay.
( ) I understand and agree that I must be sober of any drugs or alcohol for at least 14 days before attending or I will be asked to not attend or to leave without any refunds and that Vita wellness is not a detox center.
( ) Disclaimer, I understand that if I am attending the Dependance behavior reset retreat that Vita wellness and its clinicians shall not be liable for any damages, claims, liabilities, costs, or obligations arising from the use or misuse of substances or activities. We are not responsible for any outcomes or relapses.
Vita wellness is committed to ensuring that the health information of our
clients are treated with respect and safeguarded to ensure privacy.
If not attending this retreat write NA
( ) I understand that if I have any concerns about my Retreat I will contact and deal with Vita wellness directly and that if I write any untrue slander online Vita wellness will take legal action.
( ) All Money received by the client can and will be dispersed by the company in different areas and used as per our discretion.
( ) I can confirm I am attending of my own free will.
Vita Wellness Retreat’s Policies Cancellation Policy and Terms:
● Vita Wellness Retreats booking requires payment for the entirety of the Retreat at the time of booking and is non-refundable for any
● If there is an appropriate reason for needing to reschedule your
retreat may be rebooked if asked for and approved at least 14-days
prior to your Retreat date.
● Once you cancel there will be NO window to reschedule,
rebook, or transfer. And no refunds will be given for any deposit
or payment made for any reason.
● All pre-booked services are Non-refundable.
● Retreats are only valid to book or rebook for up to one year from
the purchase date.
*If all forms are not signed and sent back before arrival the retreat will not be able to begin. *
*Please be aware that we do not give out itemized invoices for our retreat packages, a paid invoice can be requested but insurance companies do not cover our packages and we cannot supply itemized invoices to them*
1. Gratuity, Credit card, and Tax fee of 15% will be charged on the total retreat amount.
2. For any date changes made a $100 fee will be applied.
3. If the Retreat is booked on a Holiday or long weekend a 3% fee will be added.
If you add any additional services to your retreat during your stay, you will be required to pay for them at the end of your retreat along with all
taxes, gratuity, and CC processing fees. Any services that are not listed on your original Itinerary are considered additional services.
If you contact your coach for additional coaching sessions outside of the allotted work hours shown on your itinerary, unless for an emergency, additional fees may be added.
-We will hold the credit card provided on file for any additional services, incidentals, or unauthorized disputes.
If you choose to leave early, (FOR ANY REASON) there will be no credits, no refunds, or transferrable days. You cannot transfer any remaining days to somebody else.
Late Check-Ins Policy:
Your reservation will only be held up to 1 hour from your check-in time unless special requests have been made prior to your retreat.
Late Check-Outs Policy:
Late check-outs after 12:00 pm are a $50 fee, if able to accommodate.
Early Check-in Policy:
Early Check-in/pick-up $50 fee is applied anytime if you arrive or need to be picked up before 2:30 pm, if able to accommodate.
❖ If you are unable to attend for a COVID-19 related reason (border restriction, unwell) and give a 72 hour or more notification a full credit (credit only) will be given for your Retreat to rebook valid for up to one
year from the retreat start date.
❖ If less than 72-hour notification is provided one night's stay will be forfeited but the remainder of the retreat will be given a credit only to be
rebooked, no refunds will be given. You must show proof as to why you are unable to come and a date change fee may be applied.
In consideration of my participation in the foregoing, the undersigned acknowledges and agrees to the following:
-I am aware of the existence of the risk to my physical appearance at the venue and my participation in the activity of the Organization that may
cause injury or illness such as, but not limited to Influenza, MRSA, or COVID-19 that may lead to paralysis or death.
- I have not experienced symptoms of fever, fatigue, difficulty in breathing, dry cough, or exhibiting any other symptoms relating to COVID-19 or any communicable disease within 14 days before attending.
- I have not, nor any member(s) of my household, traveled by sea or by air, internationally within 30 days before attending.
- I did not, nor any member of my household, visit any area within the
The United States or Canada was reported to be highly affected by COVID-19, 30 days before attending.
- I have not been, nor any member(s) of my household, diagnosed to be infected with COVID-19 virus within 30 days before attending.
Following the pronouncements above I hereby declare the following:
- I am fully and personally responsible for my own safety and actions while and during my participation and I recognize that I may be in any
the case at risk of contracting COVID-19.
- With full knowledge of the risks involved, I hereby release, waive, discharge the Organization, its board, officers, independent contractors,
affiliates, employees, representatives, successors, and assigns from any and all liabilities, claims, demands, actions, and causes of action whatsoever,
directly or indirectly arising out of or related to any loss, damage, injury, or death, that may be sustained by me related to COVID-19 while participating in any activity while in, on, or around the premises or while using the facilities that may lead to unintentional exposure or harm due to COVID-19.
- I agree to indemnify, defend, and hold harmless the Organization from
and against any and all costs, expenses, damages, lawsuits, and/or liabilities or claims arising whether directly or indirectly from or related to any and all claims made by or against any of the released party due to injury, loss, or death from or related to COVID-19.
By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary
consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.
This General Release of Liability:
II. LIABILITY EVENT. Under the terms of this Release and sufficiency of which is hereby acknowledged, the Releasor hereby releases and forever discharges the Releasee: Vita wellness Retreat (“Liability”).
THEREFORE under the terms of this Agreement and sufficiency of which is hereby acknowledged, do hereby release and forever discharge the Releasee including their agents, employees, successors and assigns, and their respective heirs, personal representatives, affiliates, successors and assigns, and any and all persons, firms or corporations liable or who might be claimed to be liable, whether or not herein named, none of whom admit any liability to the undersigned, but all expressly denying liability, from any and all claims, demands, damages, actions, causes of action or suits of any kind or nature whatsoever, which now have or may hereafter have, arising out of or in any way relating to any and all injuries and damages of any and every kind, to both person and property, and also any and all injuries and damages that may develop in the future, as a result of or in any way relating to the Liability.
If an unauthorized dispute has been made after attending the credit card on file will be charged for the full amount of the retreat package that was purchased.
We do not provide itemized price brake down invoices as insurance companies do not cover our retreats.
YES, I agree to ALL the terms above
-Once I submit this form I give permission for Vita Retreats to charge the credit card I provided and I understand that by submitting I am committing to these dates and have booked, no changes will be made. And that this is non-refundable for any reason, If I have made plans for another payment method (E-transfer) I understand that if payment is not sent within 24 hours my credit card will be charged instead.