Name *

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Date of Birth *

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Home Address *

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Phone *

Country

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Emergency Contact Name *

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Confirm you are able to walk alone for 3 hours at 3mph and are comfortable in the dark (you will be no more than 100m away from your team mates) *

YES

I agree to the following cancellation policy. *

28 DAYS OUT = 75% refund 14 DAYS OUT = 50% refund  7 DAYS OUT = 0% refund

YES

PLEASE READ THE FOLLOWING *

ZERO Retreats, Events, Workshops & Experiences Facilitator Andrew Caine (ZERO Human Industries Limited) Overview: ZERO Retreats, Events, Workshops & Experiences (The Activity) are deeply experiential and may involve intense physical, energetic, and emotional release along with physiological and mental adaptations. Therefore, persons with a history of the below contraindications should consult their healthcare provider before participating in this work and do so entirely at their own risk. Important Contraindications: Breathwork, cold immersion and emotional release practices with Andrew Caine and Natalie Steward are not advised for persons with a current or history of the following, Cardiovascular Disease, including Angina or Heart Attack High Blood Pressure Glaucoma Retinal Detachment Osteoporosis Significant recent physical injuries, and/or surgery. Severe Mental Illness, Bipolar Disorder Seizure Disorders Using major medications, Under the influence of legal or illegal drugs with impaired capacity. Personal or family history of Aneurysms. Pregnant Persons Asthma should bring their inhaler and consult with their doctor Coronavirus or Flu-Like Symptoms Broken skin or open wound / recent surgery / infectious skin condition. Diabetes / Insulin should not be taken prior to Ice immersion. Raynaud's Syndrome, Frost bite or particularly sensitive to cold and cold water. WAIVER & RELEASE In consideration of the risk of injury while participating in the activity, and as consideration for the right to participate in the activity, the Participant hereby, for the Participant, his/her/their heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enters into this waiver and release of liability and hereby waives any and all rights, claims, or causes of action of any kind whatsoever arising out of his/her/their participation in the Activity against Andrew Caine (Zero Human Industries Ltd), Tom Waller , Natalie Steward, Paul Winsper, Christian Malcolm herein referred to as the “Company” “we,” or “us”. Participants acknowledge that he/she/they has read and understood this Waiver and Release, its contents and impacts and accepts these Terms and Conditions. Further, the Participant hereby releases and forever discharges the Company, and all affiliates, managers, agents, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss that the Participant may suffer as a result of participation in the aforementioned Activity, including any claims arising from Participant performing the breathing technique, cold immersion, movement learned or taught in class on your own at home. Participant also waives any claims that may arise from traveling to and from an event related to this Activity. Participant accepts and agrees to this Waiver and Release willingly and freely. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of the Company, and all affiliates, managers, agents, staff, facilitators, volunteers, heirs, representatives, predecessors, successors and assigns. In the event that Participant should require medical care or treatment, Participant agrees to be financially responsible for any costs incurred as a result of such treatment. Participant is aware and understands that Participant should carry his/her/their own health insurance. In the event that any damage to equipment or facilities occurs as a result of Participant’s wilful actions, neglect or recklessness, Participant acknowledges and agrees to be held liable for any and all costs associated with such action. Participant affirms that he/she/they is of the age of 18 years or older, and that Participant is competent to agree to these Terms and Conditions. Participant certifies that he/she/they has read these Terms and Conditions, that Participant fully understands their content and that these Terms and Conditions cannot be modified orally.

I HAVE READ AND UNDERSTOOD THE WAIVER AND CONTRA-INDICATIONS ABOVE.