August 12-18, 2017

Please fill out a separate registration form for each participant. A $100 non-refundable deposit is required and will be applied to your tuition. First payment (half of total tuition) is due by February 1, 2017. Final payment is due by May 1, 2017. If a minimum threshold of 10 is not met, the program may be cancelled and all money including deposit will be refunded. You may still register, space permitting, up until the retreat begins.

We offer van transportation from Portland International Airport (PWM) to Medomak on Saturday, August 12th, leaving at 2:00 pm and arriving at Medomak at 3:30 pm. Additionally, we will provide the same transportation from Medomak to Portland International Airport on Friday, August 18th, leaving at 9:30am and arriving at the airport at 11:00am. Please indicate below if you would like this additional service.

Check-In is between 3:00pm-5:00pm on Saturday, August 12th.
Check-Out is by 10:00am on Friday, August 18th.

If you would like to arrive early or extend your trip, there are two Bed and Breakfasts in town. The Firs of Maine (located across the lake) is available for $125/night. And Blueberry Fields is also available, for comparable rates. Both fill up fast, so book early.

Pricing

Tuition is inclusive of all food, lodging, facilities and classes

All-Inclusive Tuition w/Private Cabin – $1295*
All-Inclusive tuition w/Shared Private Cabin – $1095*
Participants traveling in pairs, or individuals looking to share a cabin may do so for this discounted rate
All-Inclusive tuition w/Dorm style cabin – $995*
Space Limited to 6 male and 6 female participants
Van Ride from Portland Airport to Camp – $52.75**
Van Ride from Camp to Portland Airport – $52.75**

*includes 8% Maine state meals and 9% lodging tax
**includes 5% Maine state sales tax

Details

Private Cabins have full bath with hot water, and are furnished with two twin beds.
Dorm cabins have full bath with hot water, and are furnished with 6 twin beds.
A set of linens and towels are provided for the week

Payment

Checks should be made payable to Medomak Camp and mailed with completed form to:

Prior to June 1st:
13220 Westmeath Lane
Clarksville, MD 21029

After June 1st:
178 Liberty Rd.
Washington, ME 04574

Feldenkrais Retreat Registration

August 19 - 25, 2023

Please fill out a separate registration form for each participant. A 10% non-refundable deposit is required and will be applied to your tuition. First payment (half of total tuition) is due in February 2023. Final payment is due in May 2023. If a minimum threshold of 20 is not met, the program will be canceled and all money, including deposit, will be refunded. You may still register, space permitting, up until the retreat begins.
Cancellation Policy

Cancellations within 14 days of your arrival will result in a full credit applied toward a future stay at Medomak.  In the event Medomak must cancel a program, a full refund will be given.

Cancellations must be made by speaking with a Medomak Director.

A $25 cancelled check fee will be charged for returned checks.

Check-In is between 3:00pm-5:00pm on Monday, August 19th.
Check-Out is by 10:00am on Sunday, August 25th.

"Note to participants intending to register as a household: a separate registration (and payment) must be completed for each individual."

If you have any questions please call us at 1-866-Medomak, Monday-Friday 9AM - 5PM.
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region Country
ZIP / Postal Code
Phone*
Phone*
Email*
Tuition*
Price includes Maine state meals and lodging tax.

Double Occupancy Cabin - $1,740.00

Single Occupancy Cabin - $2,280.00
Do you know with whom you are sharing your cabin?*

Yes

No
Name of cabin mate. (They will still need to register and pay separately from this registration)
If you would like to share a cabin, but don’t have a specific person in mind, please provide us with the following information so that we can best match you with a suitable roommate. We will do our very best to pair participants, but we cannot guarantee outcomes.
Your Age
Please enter a number from 1 to 99.
Sleep Questions
Please check all that apply.
Are you a morning person?
Do you stay up late?
Are you a light sleeper?
Do you snore?
Van Ride from Portland Airport to Camp? (@$55.00)

No

Yes
Van Ride from Camp to Portland Airport? (@$55.00)

No

Yes
Total Due
$0.00
Expected Arrival Time*

: Hours

Minutes

AM/PM
How did you hear about us?
What is your experience with Feldenkrais in general?
MEDOMAK RETREAT CENTER PERSONAL INFORMATION & ACTIVITY WAIVER

Welcome to the Medomak Retreat Center! We’re excited that you will be joining us for the Feldenkrais ® Retreat. To serve you better while you are here, please provide us with the following information:
Waiver Name*
First Last
Phone*
Phone*
Email*
Date of Birth*
MM slash DD slash YYYY
This is my _____________ retreat at Medomak.*
Date of Last Tetanus Shot*
MM slash DD slash YYYY
Date of Last Physical*
MM slash DD slash YYYY
Hidden
COVID Vaccine
If already vaccinated, please upload a copy of your COVID vaccine record. If vaccine isn't available to you yet, please bring copy upon arrival.

Drop files here or

Accepted file types: jpg, pdf, Max. file size: 512 MB, Max. files: 8.
Allergies*
N/A
Medications You Take*
N/A
Have you had recent or past medical conditions or treatments that could affect participation in physical camp activities? If so, please describe.*
N/A
Dietary Considerations
We provide well-balanced, varied meals. With notice, we can accommodate vegetarian/vegan diets. All meals have essential components that are gluten free, but folks with celiac disease may be concerned that our kitchens cannot account for cross-contamination. Folks that prefer to eat gluten free may wish to bring along personal items to supplement their preferences. If you would like Vegetarian or Vegan meals please select below.

Vegetarian

Vegan
Swimming Ability*
Emergency Contact
Emergency Name*
First Last
Relationship
Emergency Phone*
Emergency Phone*
Primary Care/Family
Physician*
Physician Phone*
Physician Phone*
Insurance Provider*
Group Number*
Additional Information You'd Like to Provide
Retreat Center Waiver

We all must be fully aware that there are potential risks and dangers inherent in engaging in outdoor recreational activities and in living in an outdoor camp environment. To heighten awareness, upon arrival at the Retreat Center, each retreat participant (as well as any adult or minors accompanying the retreat participant) must participate in a mandatory safety orientation where retreat center rules and regulations are discussed. As part of the orientation each participant and accompanying adult or minor(s) will have the opportunity to ask questions or seek clarification as to any issues related to being at the retreat center. The majority of the rules are cited in our Campers Handbook. We advise retreat participants to review the Handbook upon arrival at the retreat center. A copy of the Handbook can be found in your cabin. If you would like to obtain a copy of the Handbook prior to coming to camp, you can contact Medomak Camp by email or phone to receive a paper copy.

Each of the retreat participants (and other adults or minors accompanying the participant) as entered in the registration form, acknowledge will take the opportunity once at the retreat center to read the Camper Handbook, discuss any issues with companions or ask any questions of Medomak Camp staff. Through this means, additional information provided on the Medomak Camp website, and conversations with Medomak Camp staff, entry of each name further signifies that retreat participants and any adults or minors accompanying are making an informed decision regarding attendance at Medomak Retreat Center, and understand and accept all of the terms of attending Medomak Camp and Retreat Center. Entry of each name acknowledges further understanding and agreement that all activities undertaken by any retreat participant (or person accompanying the retreat participant) are done so “at your/their own risk.” Further, entry of each name acknowledges agreement to release Medomak Camp and Retreat Center, its owners, officers, employees, agents, and representatives from any and all claims for loss or damage of property and/or personal injury sustained at Medomak Camp or Retreat Center while engaging in activities associated with Medomak Camp or Retreat Center.
I agree*
I confirm permission to provide medical treatment for myself as well as any additional family members & non-family members listed above.*
Consent of Use of Photos and Statements

We have found that over the years, the photos and comments provided by attendees of Medomak are our best kind of marketing. The impact of individuals telling others of their experience at our family camp and/or retreat center has proven very powerful in our effort to grow and be successful. By signing this consent, you are agreeing to let us use any photos or comments that we can attribute to your time at the camp or retreat center. Please do not feel obligated to sign this consent. However; if you do sign, we want to thank you for your consideration.

I agree that photographs and statements of or about my experience at the Medomak Retreat Center may be used in promoting the camp or its related activities.
I consent the use of photos and statements.*

I confirm consent to the use of photos and statements for family members & non-family members listed above.*

I do not consent to the use of photos and statements for family members & non-family members listed above.
Permission to Treat

Any/all activities in which you engage at Medomak Retreat Center are “at your own risk”, and unfortunately there are occasional opportunities for injuries. For the typical situation at Medomak Retreat Center, should any accident with injury occur, participants are usually able to act on their own behalf to make decisions as to the type and extent of medical treatment. Medomak staff on hand at the time will always seek to assist based on their first-aid training in consultation with the participant. Should an adult be injured such that they are unable to exercise their authority to make a decision as to type and extent of medical treatment, Medomak staff may need to take immediate action. To allow for immediate treatment should you not be able to exercise your authority, Medomak requires that you give permission for Medomak staff, in consultation with medical personnel, to provide either routine or emergency medical treatment.

Entry of your name in the statement below signifies that you grant permission for Medomak to provide medical treatment as provided in the statement. A parent or guardian may acknowledge approval for any minors (under 18) under their expressed guardianship.

I grant Medomak personnel, as well as other medical personnel selected by the Medomak Director to administer medical treatment, including hospitalization; to administer medications; to order X-rays, routine tests, treatment; to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for the named person who is attending a retreat or conference at Medomak Retreat Center. In the case of any minor (less than 18 years) this approval applies in the event the parent/guardian cannot be reached in an emergency. In the case of an adult, approval applies if in the opinion of the Medomak Director the injured adult is unable to participate in medical decisions. This completed form may be photocopied for trips away from the Retreat Center.
Permission granted.*
I confirm permission to provide medical treatment for myself as well as any additional family members & non-family members listed above.*
CORONAVIRUS / COVID-19 WARNING & WAIVER

COVID-19 is an extremely contagious virus that spreads easily through person-to-person contact. COVID-19 can lead to severe illness, personal injury, permanent disability, and death. The COVID-related policies and procedures developed and put forward as part of the process whereby each prospective retreat participant registers are designed to the fullest practical extent possible to minimize risk of infection and/or spread of the virus to participants as well as any person accompanying participants who will be attending the retreat or occupying any part of the Medomak Retreat Center property.

As a registered participant of a Medomak Retreat Center retreat or conference program, I have thoroughly read Medomak Retreat Center’s COVID policies and procedures. I have exercised the opportunity to ask Medomak Retreat Center representatives all questions that I deem necessary to make an informed decision regarding occupancy and/or retreat attendance at Medomak Retreat Center. By affirming this waiver, I understand and accept, and agree to the best of my ability to observe and adhere to the COVID-related regulations stipulated in the Medomak COVID policies and procedures. Specifically, my endorsement signifies compliance with procedures that relate to:

Requirement for Vaccination

Monitoring and Testing while at Medomak

Medomak Mask Policy

Covid Exposure

I agree on behalf of myself as well as any minor in my custody either occupying the Medomak Camp and Retreat Center property and/or attending the retreat to release Medomak Camp and Retreat Center, its owners, officers, employees, agents, and representatives from any and all claims that relate to any illness due to COVID infection acquired during or as a result of my occupancy on the Medomak property or participation in the retreat.
I agree*
I confirm consent and agreement to this COVID waiver for myself and any minor in my custody *
PROOF OF VACCINATION

I understand that if vaccine isn’t yet available for me or any minor in my custody, I may still register now, and may later cancel my registration (and have my tuition creditable to a future stay) if full vaccination is not available to me or a family member prior to my arrival at camp.
I agree*
I acknowledge proof of vaccination may be required for entrance to Medomak, and I will be sure to bring along a copy of COVID vaccine record(s) for myself and any minor in my custody, or submit to Medomak prior to arrival.
PAYMENT, REFUND & CANCELLATION POLICY

By submitting a deposit for the Feldenkrais Retreat you agree to the following refund policy:

A non-refundable deposit must accompany your registration form to reserve your space.

The full balance is due by May 1. After May 1, payment in full is due upon registration.

Cancellations within 14 days of your arrival will result in a full credit applied toward a future Medomak retreat. In the event Medomak must cancel a program, a full refund will be given.

Sorry but Medomak cannot be responsible for nonrefundable airline tickets or other travel or indirect expenses associated with cancellations.)

A $25 cancelled check fee will be charged for returned checks.

Reservations are taken on a first come, first served basis.

Cabin assignments will be based on availability. We make all attempts to accommodate cabin requests, but final assignments are subject to the program needs of Medomak Retreat Center.

A cash discount of 2.6% will be applied to payments made via check, or money order.  To select this form of payment, choose Pay by Check. You will be emailed an updated invoice.

Cookie	Duration	Description
cookielawinfo-checkbox-analytics	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional	11 months	The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance	11 months	This cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy	11 months	The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.

August 12-18, 2017

Pricing

Details

Payment

Feldenkrais Retreat Registration

MEDOMAK RETREAT CENTER PERSONAL INFORMATION & ACTIVITY WAIVER

Emergency Contact

Primary Care/Family

Retreat Center Waiver

Consent of Use of Photos and Statements

Permission to Treat

CORONAVIRUS / COVID-19 WARNING & WAIVER

PROOF OF VACCINATION

PAYMENT, REFUND & CANCELLATION POLICY

A cash discount of 2.6% will be applied to payments made via check, or money order. To select this form of payment, choose Pay by Check. You will be emailed an updated invoice.

A cash discount of 2.6% will be applied to payments made via check, or money order.  To select this form of payment, choose Pay by Check. You will be emailed an updated invoice.