Start Your Journey Course Registration Form Cultivate your happiness today. Name * First Name Last Name Email * Phone * (###) ### #### Occupation I understand that Ritam Meditation and/or the advice given by any representative of this company is not intended to be a substitute for professional medical diagnosis or treatment. * Yes Are you currently under the care of a medical professional? * Yes No If “Yes,” please list the names of the medication that you are currently taking * How did you hear about Pure Ritam? Social Media Search Engine (Google, Bing) Newsletter Friend I can attend all four consecutive days of the course. * Yes No I can attend all four consecutive days of the course. Yes No I would like to pay my course fee in: * One full installment Over 5 installments Over 7 installments I understand that payment of the first or full installment is due no later than 3 days (72 hours) prior to Day 1 of the course. Yes No COVID LIABILITY WAIVER: I acknowledge the contagious nature of the COVID-19 virus, and respect that Pure Ritam LLC adheres to the CDC recommendations of practicing social distancing and wearing face coverings. I further acknowledge that Pure Ritam LLC has put in place preventative measures to reduce the spread of the COVID-19 virus, to the best of her abilities. I further acknowledge that no guarantee exists regarding whether or not I may contract COVID-19. I understand that the risk of becoming exposed to and/or infected by the COVID-19 virus may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff and other students. I acknowledge that I increase my risk of exposure to COVID-19 by participating in services rendered. I acknowledge that I must comply with all set procedures to reduce the spread while in attendance. I attest that: (1) I am not experiencing any symptom of illness such as cough, shortness of breath, difficulty breathing, fever, chills, muscle pain, headache, sore throat, or new loss of taste or smell. (2) I have not traveled internationally within the last 14 days (3) I have not traveled to a highly impacted area within the United States in the last 14 days. (4) I do not believe I have been exposed to someone with a suspected and/or confirmed case of COVID-19. I hereby release and agree to hold Pure Ritam LLC harmless from any causes of action, claims, demands, damages, costs, expenses and compensation for damage to myself that may be caused by any act, or failure to act, or that may otherwise arise in any way with any services received. I understand that this release discharges the aforementioned from any liability with respect to bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received. * Non-agreement to the terms will result in the inability to participate in the course. I agree to the terms I do not agree to the terms By checking the box below, I am electronically agreeing to disclosing my information to Pure Ritam and its representative. Yes I would like to subscribe to the Pure Ritam newsletter. Yes Thank you!
