Retreat Dates (Please select preferred retreat. If you wish to join us for both, please select both by holding down the 'Shift' key and clicking on each):

Retreat Accommodation Preference

Full Name (as per passport):

Preferred name (what would you like us to call you?):

Pronoun:

Email:

WhatsApp Phone Number (include your country code):

Gender:

Date of Birth:

Current occupation:

Nationality / Citizenship:

Address:

City:

ZIP / Postal Code:

Country:

Instagram account name?

How did you hear about us?

If through Google, Blog or friend, please provide URL or name?

Are you 100% independent?

If no, please thoroughly explain your disability, limitations, disease or condition/s? Will you have a support person to join you on the retreat?

Do you have any physical limitations, sensitivities, injuries, conditions or other?

If yes, please thoroughly explain your physical limitations, sensitivities, injuries, conditions or other?

Are you currently taking any form of medication?

How frequently do you practice yoga (daily, weekly, monthly)?

How long have you been practicing yoga? Please explain experience and styles of yoga explored.

What do you hope to get out of this retreat?

Is there anything else that would be helpful for us to know about you or your past? (e.g. addiction, social therapy, anxiety issues, etc)

Have you got any fears or apprehensions about the retreat?

Have you ever received professional medical treatment due to any psychological condition?

Do you have any specific requests?

EMERGENCY CONTACT - Full name:

EMERGENCY CONTACT - Relationship to you:

EMERGENCY CONTACT - Email address:

EMERGENCY CONTACT - WhatsApp Contact phone number (please include country code and full number, as per WhatsApp phone display. This number will only be used in the case of an emergency so it is important that it is correct):

Please select to note that you agree to our Code of Conduct, Terms & Conditions and Refund Policy.

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