Please complete the following registration form
What is your name? *

What is your address? *

What is your date of birth? *

What is your telephone number? *

What is the name of your emergency contact? *

This might be a parent, friend or next of kin
What is the phone number of your emergency contact?

What do you hope to gain from this retreat? *

Have you practiced yoga before? *

If yes, what is your preferred style?

Style, tempo, time of practice, etc
How is your general health and wellbeing? *

This can cover physical, emotional and/or mental aspects
Have you suffered from any of the following?

Please check any/all that apply

Please give a brief description below

If you checked any boxes above, or have anything else to include
Are you pregnant? *

Have you recently given birth? *

Are there any other aspects of your health you would like to share?

If so please give a brief description below
Do you have any specific dietary requirements? *

If you have any special dietary requirements please give details below

The food will be free range vegetarian (may include nuts, eggs and dairy)
On what basis would you like to join the retreat? *

Early bird 10% discount if booked before 28th October.

How did you hear about the retreat? *

Email mailout, printed poster, Facebook, word of mouth, friend, etc
Thank you for completing this form. If you have any questions, please contact Katy on 07748849829 or

Thanks for completing this typeform
Now create your own — it's free, easy, & beautiful
Create a <strong>typeform</strong>
Powered by Typeform