Wellness Adventures Registration

Please fill out the following information, and we will contact you within 2-3 business days. For information about (Re)Discover Your Wild Side: Mindfulness Program and Wilderness Retreat, please email Dr. Elizabeth Slator, Associate Director, at eslator@rice.edu.

 

General Information 

Name:  
Date of Birth (MM/DD/YYYY):  
Rice Affiliation:  
Mailing Address:     
Email:  
Phone (Cell):   
Phone (Home):  
Name and Number of Emergency Contact    
Occupation/Work Status:  
Relationship Status:  
Number of Children:  
 

Average hours slept at night/Quality of sleep:   
Please indicate any past or present medical conditions or physical injuries:      
Medications:   
What kind of exercise do you manage to do each week/frequency?      
Do you or have you ever meditated? 

  

Do you or have you ever practiced yoga?      
Do you smoke? If yes, how many cigarettes a day?   
Alcohol/recreational drug use/frequency:   
History of depression or anxiety:      
Are you currently undergoing therapy for mental health reasons? If yes, please explain.      
What do you care most about in your life?      
What are your greatest worries or stressors?      
Is there anything else you would like for me to know about you?      

             


Trip Cost 

Rice Affiliate: $750/$650      
Non-Rice Affiliate: $900/$800
Includes: Accommodations, meals and local transportation

Wellness Adventures Policies and Agreement

Payment Policy

Total trip cost must be paid in full prior to April 1, 2018. Payments MUST be paid online through the Recreation Center website.

Risk Factor Notice

Participants must be cleared of any risk factors associated with physical activity prior to beginning the program. If a participant is identified as high risk, the participant must provide a signed physician's medical release form stating that the participant has been cleared to engage in physical activity.

Refund Policy

Refund requests must be submitted in writing (email), and will be assessed on a case by case basis. Cancellation of registration made less than two weeks (14 days) prior to the first class of the program will not eligible for a full refund, no matter the circumstance. Due to administrative costs, there will be a fee of $40 associated with each refund request. 

 

                                        

 

Participation Agreement and Assumption of Risks and Liability

I, , desire to participate in the activities and programs of the Barbara and David Gibbs Recreation and Wellness Center (the "Activities") and, in consideration of being allowed to participate in the Activities and to use the machinery and equipment of the Barbara and David Gibbs Recreation and Wellness Center (the "Facilities"), I do hereby acknowledge and agree as follows.

1. I am fully informed and aware that my participation in the Activities and use of the Facilities involve certain risks, including, but not limited to, property damage and loss, bodily injury, illness and even death. I fully assume any and all risks.

2. I am in sufficient physical and mental health to participate in the Activities and to use to Facilities. I have medical insurance coverage appropriate for my participation in the Activities and use of the facilities, and I have provided medical insurance and emergency contact information below my signature on this agreement. I understand that Rice University shall not provide any insurance for me in connection with my participation in the Activities or use of the Facilities.

3. I fully and forever release, waive and discharge, and covenant not to sue Rice University (including but not limited to, its trustees, faculty, staff, students, agents, and representatives), from and for any and all demands, claims, actions, suits, damages, losses, liabilities, costs and expenses (including, but not limited to, court costs and attorneys' fees), from any cause whatsoever (including, but not limited to, property damage or loss, bodily injury, illness, or death) directly or indirectly arising in connection with my participation in the Activities or use of the Facilities, whether or not foreseen or contributed to by the negligent acts or omissions of Rice University or others.

4. This Agreement constitutes the entire agreement, and supersedes any prior or contemporaneous agreements, regarding this subject matter. The Agreement (i) may not be amended, by course of conduct or otherwise, and (ii) may not be assigned, in whole or part, except in writing duly executed by Rice University. This Agreement shall be interpreted and enforced in accordance with the laws of the State of Texas, without regard to any conflicts or choice of law principles, and shall be as broad and inclusive as permitted by such laws. If any provision of this agreement is held unenforceable by a court, such unenforceability shall not affect and other provision, and this Agreement shall be construed as if such provision, to the extent of such unenforceability, had not been incorporated herein.

5. I (i) have read and fully understand this Agreement, (ii) intend that this agreement be legally binding upon and enforceable against me and my family, estate, heirs, and legal representatives, (iii) intend that this agreement benefit Rice University, (iv) confirm that I am at least 18 years of age, fully competent, and am entering into this Agreement voluntarily and of my own judgment.