Enter your date of birth in “dd-mm-yyyy” format. For example, if your birthday is 3rd May, 1980, enter 03-05-1980. *
Your Retreat Date
Your Favourite Band / Song
Have you done Yoga before? Yes/No.
If yes, what type(s) and for how long?
Do you practice physical exercise? What kind? and for how long?
Do any of these health conditions apply to you?
High blood pressureLow blood pressure/faintingArthritisDiabetesEpilepsyHeart problemsAsthmaDepressionDetached retina/other eye problemsRecent fractures/sprainsRecent operationsBack problemsKnee problemsNeck problemsRecent pregnanciesAre you pregnant?
Do you have any other conditions which affect your mobility or are likely to cause
you concern when doing Yoga?
If Yes, give details:
Which aspects of Yoga most interest you? Please tick as many as you wish:
Physical postures (asanas)RelaxationChanting & HealingBreathwork (pranayama)MeditationAshtangaVinyasaHathaNutrition
Do you have any food intolerance? Please detail any type of food that can not take.
Single OccupancyDouble Room, SharedTwin Room, Shared
How did you first hear about this yoga retreat? (Details are appreciated)
I take full responsibility for my health during the yoga classes, including any injuries.
I will inform my yoga teacher of any medical changes.
Thank you for filling out the questions!
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