Name of Person in Charge *

First Name

Last Name

Address *

For Invoice

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Event/workshop *

MM

DD

YYYY

Time of Workshop/Event *

Hour

Minute

Second

AM PM

Finish time of Workshop/event

Please include prep and tidy up time

Hour

Minute

Second

AM PM

Agreement *

I am fully insured and qualified for all activities that are provided in the Escapada Health space in my workshop/event. I fully understand that I am responsible for my participants and any liability as a result of malpractice lies with me. The space provided by Escapada is a purely rental space and not affiliated with the teaching or practicing of my workshop/event

I AGREE