FULL NAME

EMAIL ADDRESS

CONTACT NUMBER

PLEASE TICK PLEASE TICK I hereby confirm that I accept the risks involved with any physical activity/physical movement and other activities that I may participate in this program. I confirm that I am voluntarily participating in all activities at my own risk, and accept responsibility for myself. Inner Journey with Kaya, and Kaya Slater are not liable for any injuries or risks or for me in any way. I accept full responsibility for myself.. I understand there are no refunds given for programs with Kaya.

Please let us know if there is anything else we should know about before you proceed with this program.