Retreat Registration Form

I'm thrilled you want to RETREAT with me! Please complete the form below so I can be sure to provide you with a wonderful Yoga Retreat...

Name

Phone

Have you practised yoga before? If so, for how long?

Do you have any injuries or health concerns? If so, please provide details below.

Do you experience any of the following? Neck & shouder tension / back ache / difficulty sleeping / stress / anxiety / depression?

What would you like to get out of yoga?

How did you hear about Gem Yoga & Wellness?

If you are pregnant, have high or low blood pressure or have a detached retina, please state here so we can discuss before class.

Catering Needs: As there will be food & drink provided on your retreat, please state if you have any allergies, dietary requirements, or anything you just won't eat!

Yoga & Personal Needs: Feel free to tell me what you'd like to get out of your day or how you would like to feel. Do you require anything to bring more comfort to your yoga & to you? Are you going through something sensitive that I need to be aware of?

I agree

I agree that any information, instruction or advice from Gem Yoga & Wellness may NOT be used as a substitute for my Doctor's advice or treatment. I understand that I should consult my doctor before starting a new exercise programme and stop immediately if I feel unwell, or any pain or discomfort.

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Retreat Registration Form

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