Save your spot now for 2026 Restore & Reconnect a women’s yoga retreat You will be sent payment instructions once you have completed this form. Name * First Name Last Name Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Name of roommate (if signing up with someone) First Name Last Name Retreat Details Location: Santosha at Hillholm Estate, Kingfield, ME Thurs, Oct. 22nd – Sun, Oct. 25th, 2026 Included: - 3 nights/ 4 days single or double occupancy room with private bathroom - 4 daily meals - Daily yoga classes and workshops with Jill Braverman (or equivalent instructor/s in case of emergency) - Use of yoga props such as mats, blocks, bolsters, blankets and straps - Special evening program/s TBA Cancellation Policy Once you register for a Retreat, your payment is non-refundable. Retreat payments are transferable, with permission of the retreat leader, if for some reason you need to transfer your spot to another guest. In case of a transfer occurring, financial exchange will happen between said registrant and replacement guest. While we realize “life happens,” our policies are FIRM, as we only have so many retreats available, and only so many spots to offer in each retreat. Retreats fill quickly, so please choose your special retreat wisely and joyfully! We strongly suggest Travel Insurance for your trip. I understand and agree to the above Cancellation Policy * Yes Release & Waiver I agree to the following: That I am voluntarily participating in the Yoga Retreat offered by Jill Braverman, during which I will receive instruction about yoga and health. I recognize that yoga requires physical exertion. I am fully aware of the risks and hazards involved and participate at my own risk. That it is my responsibility to consult with a physician prior to attending the Yoga Retreat and regarding my participation at the Yoga Retreat. I represent and warrant that I am physically fit and have no physical or mental condition which would prevent my full participation in the retreat experience. That I will assume full responsibility for any risks, injuries, or damages, known or unknown, which I might incur as a result of participating in the Yoga Retreat program. This includes, without limitation, my use of the facility, sauna, hot-tub, parking area or sidewalk and my participation in any activity, class, program or instruction. I agree that I am voluntarily participating in the Yoga Retreat and using the facilities and premises and assume all risk of injury or death to me or the contraction of any illness or medical condition that might result, or any damage, loss or theft of any personal property. I agree on behalf of myself (and my personal representatives, heirs, executors, administrators, agents and assigns) to RELEASE AND DISCHARGE Jill Braverman, Santosha at Hillholm Estate (and their affiliates, employees, agents, representatives, successors and assigns) from any and all claims or causes of action (known or unknown) arising out of my participation in the Yoga Retreat. This Release and Waiver of liability includes, without limitation, injuries which may occur as a result of (a) my use of any exercise equipment or facilities which may malfunction or break, (b) my slipping and falling while in the facility or on the premises, and (c) my travel to or participation in the Yoga Retreat. I acknowledge that I have carefully read this Release and Waiver of Liability and fully understand that it is a release of liability. I agree that neither I nor any person or entity acting on my behalf has or will file, charge, claim, sue or permit to be filed, charged or claimed, any action for legal or equitable relief against Jill Braverman and/or Santosha at Hellhole Estate, involving any matter occurring at any time or related in any way whatsoever to traveling to or participating in the Yoga Retreat. I understand and agree to the above Release and Waiver * Yes Thank you!