Be Here Now.

- Ram Dass

We’re looking forward to hosting you for a private retreat with Santosha at Hillholm Estate!

Now we want to know more about you. Please ensure that each member of your party completes the attached form upon receipt so we can plan your stay accordingly.

The more detail, the better.

Name

First Name

Last Name

Telephone

(###)

###

####

Share your Instagram account so we can stay in touch!

Street Address

Town

State, District, or Territory

Zip Code

Province/Country (if outside United States)

Date of Birth

YYYY

Pronouns (she/her, he/him, they/them, etc.)

Which private retreat are you attending?

Any injuries we should know about? Any physical, mental, or emotional limitations we should be aware of?

Please choose only one of the menus below for your stay. REGARDING ALLERGIES AND INTOLERANCES: If you have any food allergies or intolerances, please tell us in the notes at the bottom of this form. If you list any allergies or intolerances, including gluten or dairy, please tell us (1) if cross-contamination triggers your allergy (i.e., Celiac disease), (2) the symptoms of your allergic response, and (3) whether you carry an Epi-Pen in case of emergency. If you indicate that you have a dangerous allergy for which airborne allergens are triggers (i.e., Celiac disease, with airborne gluten particles in a commercial kitchen where bread is baked), we will perform a complex partition the kitchen to avoid cross-contamination. DUE TO THE NATURE OF OUR MEAL PREPARATION PROCESS, WE MUST KNOW IN ADVANCE OF YOUR RETREAT ABOUT ANY ALLERGIES OR INTOLERANCES. Given the size of our kitchen staff, we are unable to cook custom meals on demand.

Omnivore Menu - I eat meat, fish, and dairy.

Pescatarian Menu - I do not eat meat, but I eat fish and dairy.

Vegetarian Menu - I do not eat meat or fish, but I eat dairy.

Vegan Menu - I do not eat any food products derived from animals.

Any canine furry friends? Please remember that, while Santosha at Hillholm Estate happily welcomes your canine companion, it is your responsibility to ensure that your dog is comfortable in its environment and (1) will not be disruptive to other guests, (2) is comfortable around other dogs, including Pamplemousse and Winnegance, Santosha's house dogs, and (3) will not be damaging to any property. Please bring a crate for your dog in the event of emergency. Please keep your dog on a leash outside the property at all times. A fee of $50/stay applies for each dog you bring.

Tell us anything else we should know. What brings you to Santosha now? We want to know all about you: the more detail, the better.

Agreement

By selecting "Yes, I agree" below, I affirm that I have read and I understand the terms set forth in the Disclosure and Liability Waiver, Image Release, and Code of Conduct Agreement below. Selecting "Yes, I agree" below, I hereby sign my legal name to this Agreement with the date of this form submission.

SANTOSHA AT HILLHOLM ESTATE

Disclosure and Liability Waiver, Image Release, and Code of Conduct Agreement (the “Agreement”)

For good and valuable consideration, the receipt and sufficiency of which I hereby acknowledge, I agree to these terms:

I understand that classes, workshops, and programs offered by Tadasana Ventures, LLC d/b/a Santosha at Hillholm Estate d/b/a Santosha on the Carrabassett d/b/a The Inn on Winter’s Hill d/b/a Hillholm Estate (“Santosha”) and its owners, instructors, agents, employees, third-party contractors, and service providers, heirs, successors, and assigns (collectively, the “Santosha Parties”, and each, a “Santosha Party”) may include physical movements, breathing exercises, meditations, and physical adjustments and/or touch which may be strenuous and could result in physical injury. I acknowledge and affirm that the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated from the activities conducted at Santosha. If I experience any pain or discomfort, I will discontinue the activity and ask for support from the instructor or service provider. On my own behalf, as well as on behalf of my dependents, heirs, executors, successors and assigns, I hereby waive, release, acquit, forever discharge and hold Santosha and the Santosha Parties harmless from any and all claims, demands, suits or actions on account of personal injury, death, loss or property damage arising from or in any way connected directly or indirectly to my stay at Santosha or participation in any activities.

I acknowledge and affirm that yoga, movement, pranayama, meditation, and other related activities (the “Activities”) are not substitutes for medical attention, examination, diagnosis or treatment. I acknowledge that the Activities may not be recommended and/or may not be safe under certain medical conditions. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in any Activities. I represent and warrant that I am physically, mentally, and emotionally prepared to participate in any Activities I elect at Santosha (either on or off its physical premises) and I have no medical condition that would prevent my full participation in such Activities. I agree to indemnify, defend, and hold harmless Santosha and the Santosha Parties from any claim, fee, cost or expense which may be asserted against Santosha or the Santosha Parties by a third party due to my claims or use of property located at Santosha, or if I commence legal actions against Santosha, any Santosha Party, or any third party.

I also affirm that I alone am responsible to decide whether to practice any of the Activities and my level of participation in any of the Activities is my own choice and performed at my own risk. I hereby agree to irrevocably release and waive any claims I now have or may hereafter have against Santosha and the Santosha Parties.

For the avoidance of doubt, I acknowledge that both safe and unsafe use of certain amenities located both on and off the Santosha premises, including but not limited to the hot tub, sauna, tennis courts, balconies, terraces, bicycles, skis, kayaks, canoes, yoga equipment, fire pit(s), or otherwise carry the risk of personal injury, death, loss or property damage. I acknowledge and agree that I fully assume the risks inherent in my use of any such amenities.

I grant permission to Santosha and the Santosha Parties the irrevocable and unrestricted right to reproduce the photographs and/or video images taken of me or members of my family, for the purpose of publication, promotion, illustration, advertisement or trade in any manner or in any medium. I grant permission to Santosha and the Santosha Parties to use my statements, written or verbal, with or without my name, for the purpose of advertising and publicity without restriction. I acknowledge and agree that this permission may include the use of such photographs and/or video images on social media. I waive my right to any compensation for use by Santosha or any Santosha Party of such images. Santosha and/or any applicable Santosha Party shall have complete ownership of the images produced or published and shall have the exclusive right and license to make use of such images, including, but not limited to, the right of performance, display, reproduction and distribution in all media, and the right to create, perform, display and distribute derivative works of my images or my statements.

I agree to indemnify and hold Santosha and all Santosha Parties harmless from and against any and all claims, damages, lawsuits, judgments and expenses, including reasonable attorneys’ fees, that Santosha or any Santosha Party may become liable to pay or defend arising out of or caused by any appearance and/or use of the images or statements described herein.

I hereby release Santosha and all Santosha Parties from all expenses, claims, and liabilities incurred by me arising out of or in connection with any appearance and/or use of the images or statements described herein.

I understand that, following check-in, in the event I choose to leave prior to my scheduled departure date, I am not entitled to any refund from or rescheduling by Santosha for any reason.

I have read, fully understand, and agree to the terms of this Agreement. I understand its terms and intend to be legally bound by the same. By signing below, I intend to completely and unconditionally discharge Santosha and the Santosha Parties from any and all liability relating to my stay at Santosha or my participation in any Santosha Activities, both on or off Santosha’s physical premises. I further release and indemnify Santosha and the Santosha Parties from any claims or liability for property damage, personal injury or death resulting from acts or omissions of Santosha or any Santosha Party, condition of the Santosha premises or objects owned by Santosha or any Santosha Party.

I hereby represent that I have not, to my knowledge, been exposed to COVID-19 or any person or animal who has tested positive for COVID-19 or who has been exposed to COVID-19. To the extent that Santosha, any Santosha Party, the State of Maine or any local jurisdiction requires a negative COVID-19 test result and/or quarantine for persons traveling from my state or local jurisdiction, I hereby affirm that I have complied with all laws and regulations associated with same. I acknowledge that it is my sole responsibility, and not the responsibility of Santosha or any Santosha Party, to inform me of applicable laws or regulations. I hereby affirm that I have not shown any symptoms of COVID-19 in the last twenty-one (21) days. I hereby agree that, in the event that I show any symptoms of COVID-19 during my stay at Santosha, I will immediately notify the staff of Santosha and will consent to following any and all requirements of Santosha under such circumstances, which may entail leaving the premises and forfeiting amounts paid to Santosha for my stay. I agree to wear a face mask (not a gaiter, bandana, face shield, or otherwise) at all times during my stay while indoors in common spaces upon the request of any Santosha staff member. I agree to submit to infrared temperature checks daily, performed by a Santosha staff member, as requested. I agree to wash my hands and use hand sanitizer on a frequent basis, abiding by handwashing techniques propounded by the U.S. Centers for Disease Control. I agree to use all facilities on or off the physical premises located at Santosha in the manner prescribed by Santosha staff. In the event that, during or after my stay at Santosha, I (or any person related to me or affiliated with me) is diagnosed with COVID-19 or shows any symptoms thereof, I hereby irrevocably release and indemnify Santosha and the Santosha Parties from any claims, personal injury or death resulting from acts or omissions of Santosha or any Santosha Party with respect to management of COVID-19 protocols. In the event that I am diagnosed with COVID-19 or learn that I have been exposed to COVID-19 at any time within one (1) year following the date hereof, I agree to inform Santosha of same in writing, for which email shall be sufficient (hello@santosha.org).

rev. 050704