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Nature, Yoga and Meditation Day Retreat Information Form
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Name
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First
Last
Email
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Contact number
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Address
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Your date of birth
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Emergency contact name, number and relationship in case needed during the day retreat (someone other than you)
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GP name, surgery and address
Do you have any allergies? Please provide full details and whether you carry an adrenaline auto injector
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Any dietary requirements or intolerances (or absolute dislikes!) e.g. vegan, vegetarian, gluten free etc.
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If you are taking regular medication, please provide details
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Please advise below of any medical conditions, physical or learning disability that you may have.
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Are you pregnant or had a baby in the past year?
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Do you have any previous yoga and meditation experience?
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All levels including beginners are welcome.
Have you attended a retreat before? If so what type and where?
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Any other information that we may need to consider to ensure your retreat is as comfortable as possible.
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What are you hoping to gain from joining this day retreat? Eg, relaxation, fun, time in nature, creativity, socialising, flexibility, meditation practice, mindfulness, stress-relief, menopause symptom relief, mental health, meeting others, and / or anything else
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This information is helpful so that we can aim to make the day retreat enjoyable and appropriate for everyone attending. Thank you.
How did you find out about the day retreat?
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Occasionally we might use photos or videos of the retreats on our website or social media. Are you happy for us to use photos or videos that include you?
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Yes
No
Are you happy to receive emails or messages regarding our retreats' information?
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Yes
No
YOGA AND MEDITATION DISLAIMER: If at any time during the class, you feel discomfort or strain, gently stop the movement or come out of the posture and rest. You may rest at any time during the class. It is important in yoga that you listen to your body, and respect its limits on any given day. I understand that yoga is not a substitute for medical attention, examination, diagnosis, or treatment. I should consult a medical professional or midwife prior to beginning any activity program, including yoga. I recognise that it is my responsibility to notify my teacher of any serious illness or injury before every yoga class. I will not perform any movements or postures to the extent of strain or pain. I accept that neither the instructor, nor the hosting facility, is liable for any injury, or damages, to person or property, resulting from the taking the classes at this day retreat.
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Please tick to accept
GENERAL DISCLAIMER: In booking the retreat I declare that I will follow the ground rules and health and safety guidelines for this activity including the use of tools and fire. I agree to wear clothing and footwear recommended by the event organisers. The event organisers can accept no responsibility for loss or damage to personal property or for personal injury not arising as a result of its own act or default. In the event of a medical emergency, I agree to receiving emergency first aid and medical treatment including anaesthetic as considered necessary by the attending medical professional. I will disclose, in advance, any medical conditions, physical or learning disabilities that may impact on my attendance or participation of all or some of the planned events.
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Please tick to accept
Before the retreat we will contact you with more information regarding the stay including directions, what to bring and wear and planned activities. If any of your provided information above changes between now and then please send email rosannagodfrey@outlook.com to advise of the changes.
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Please tick to accept
This form, plus payment by bank transfer (£85), must be received to confirm your place on the retreat. Thank you. As we are small businesses and due to planning resources, time, venue costs, and supplies, unfortunately we are unable to give refunds
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Please tick to accept
Payment details will be emailed to you with this information form, or can be given over the telephone on request.
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