Envision Wellness Retreat 21st August- 23rd August 2020 (2 nights, 3 days) registration and deposit form


    The following provides the terms and conditions (the “Agreement”) for each participant in the Envision 2020 program. By signing this document you are agreeing to the provision of services under this Agreement. You acknowledge that this is a legally binding document and that any deviation and/or modification(s) to the terms and conditions stipulated within this document must have the written consent of the parties involved.

  • 1. Where Dr Aileen Alegado and her colleagues (hereinafter “Facilitators/Retreat Hostess”) will be running the Envision Retreat program Envision 2020 (hereinafter the “Retreat”) You or any natural person participating in the Retreat (hereinafter “Participant”) Changes Psychology (hereinafter the “Provider”) will be responsible for processing client’s bookings, billing services and client administration The dates of 21st August- 23rd August 2020 (2 nights, 3 days) inclusive (hereinafter the “Weekend”) are the set dates for the Retreat.

    2. PRIVACY: We work like a virtual clinic office, collecting and managing personal and medical information provided by you and your psychologist, which may include sensitive health information. For more about privacy, and who to contact if you have questions regarding privacy, see our Privacy Policy

    3. CONFIDENTIALITY: Due to the focus of the Retreat being healing and self-reflection many participants will share personal and sometimes sensitive information. In order to encourage a safe environment for sharing information, we require participants to respectfully listen to what other participants want to share with the group or individuals and not under any circumstances share this information with other people or via social media.

    4. COST OF THE RETREAT: The cost is per person and includes 3 meals per day, and 3 days of programmed activities. Your room type has been agreed upon consultation with Aileen and confirmation of total pricing has been sent to you via email, with a link to this form, prior to us deducting your deposit. If you get a mental health plan with Aileen Alegado's name on it before the retreat you will be eligible for Medicare rebates of $245.80.

    5. SERVICE POLICY: The Facilitators of the Retreat reserve the right to change the date, time and location (“situational change”) of the Retreat and its services due to extraordinary circumstances, including but not limited to: external forces, governmental regulations, weather and oceanic conditions, forces of nature and force majeure, etc. In the unlikely event that circumstances render this Retreat untenable for the Weekend, the Facilitators will make every reasonable effort to contact and inform the Participant as soon as is reasonably possible. The Facilitators will not be liable for the cancellation, failure of, or delay in performing its obligations under this Agreement due to the aforementioned events.

    6. CANCELLATION POLICY: Cancellation with 14 days notice will incur a 50% forfeiture of total retreat fees. Cancellations made with less than 14 days will incur a 100% forfeiture of total retreat fees. Only in extreme extenuating circumstances will refunds of any type be considered with our discretion.

    7. CLAIMING MEDICARE REBATES: Participants wishing to claim Medicare rebates for individual or group psychology sessions conducted by Dr Alegado under a Mental Health Plan are required to email us a copy of the Mental Health Plan before the commencement of the Retreat. Participants will then be required to complete a provided claiming form to enable Medicare rebates to be processed. For clients who have been referred by a GP or Psychiatrist, Dr Alegado is required by Medicare to write a letter to the referring doctor detailing your progress. If an attendee selects the Retreat package including Medicare rebates and a Mental Health Plan is not provided before the retreat, the attendee's card will have $245.80 (equivalent to the total Medicare rebates) deducted off the card they use to pay for the retreat fees. By signing this agreement you consent to communications and information sharing between Dr Alegado and your referring Doctor

    8. RELEASE OF LIABILITY: Physical injury during exercises or whilst on Retreat - No liability will be taken for any injuries or accidents that occur as part of their exercise participation. Clients are expected to advise facilitators of any injuries or diagnosed medical conditions prior to participating in physically strenuous parts of the programme and encouraged to seek their own medical advice before attending them ie. establishing appropriate levels of engagement in activities of the Retreat. This agreement releases Mindset Psychology from all liability relating to injuries that may occur. I, the “participant”, agree to hold Mindset Psychology entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence. I also acknowledge the risks involved in any type of physical activity. I swear that I am participating voluntarily and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity. I forfeit all right to bring a suit against Mindset Psychology for any reason. I will also make every effort to obey safety precautions as explained to me verbally. I will ask for clarification when needed.

    9. DATA USE & PROTECTION: The Participant consents to being photographed and/or filmed during the course of the Retreat and agrees that the Facilitators may use such recordings for promotional and/or advertising purposes upon completion of the Retreat at the Facilitators’ discretion. The Participant agrees that any personal data collected may be used for market research and quality assurance purposes and that all personal data will be treated confidentially and will not be transferred or distributed to any third party other than is necessary to fulfil the booking or services as stated above. The Participant may withdraw consent to his or her data use at any time in writing and understands that the personal data or footage of the terminating Participant will not be used for the above-stated purposes.

    10. OTHER PARTICIPATION CONDITIONS: Illicit drug use is prohibited at the retreat. You must notify us before the course commences of the use of prescribed medication. eg sleeping tablets

    Phone Use - We ask participants to be mindful of their phone use during workshops/ seminars as this may be disruptive to the group.

    Miscellaneous Items Feel free to bring necessary things with you to make you feel at home, including your own pillow, books, magazines, meditation materials that you can enjoy during your downtime.

    Pool Usage - Use of the pool is limited to daytime use up to 10pm so as not to disrupt participants staying in the pool cottage area

    Absence from Activities - You agree to notify the Retreat Hostess of your absence from any scheduled activities and/ or when leaving the property for any reason eg. walk, runs, shopping in town.

    Wellbeing - You are solely responsible for your wellbeing, including getting sufficient food and sleep during the Retreat and taking any prescribed medicines on time. If at any time you feel unwell you are to let your Retreat Hostess know and they will give you the support that you need at the time. You agree to inform any facilitators or the Retreat Hostess if you feel unwell at any stage of the course.

    Dietary/Allergy Requirements You agree to inform the Retreat Hostess and facilitators of any allergies or dietary requirements you may have so we may cater for your needs.

    Social Media - The use of Social Media during the Retreat is permitted with the express consent of each Participant that may, with or without awareness, knowledge or consent, feature in another Participant’s Social Media presence. The permission to use Social Media during the Retreat activities rest solely with each Facilitator’s discretion with the direct verbal consent of each Participant.

    If you break this agreement, then you will be asked to leave the course immediately, forfeiting the entire payment fee for the Retreat.