Application Form

1-Week Authentic Yoga Retreat

Application Form - 1-Week Authentic Yoga Retreat

Personal Information :

First & Last Name * :
Email Address * :
Phone Number (optional):
Gender :
Language(s) Spoken :
Your Age Group:
Nationality :

Travel information :

When is the start of your course (Date/Month/Year)
Number of Travellers :

Yoga Experience :

How would you put your yoga level? :
Why do you want to experience this retreat?
(Check all that apply)
Physical fitness
Peace of mind / stress relief
General Inquisitiveness
Holiday/ relaxation
Seeking higher meaning to life
Other

Health Information :

The following questions are here to help us understand you and make the retreat more productive. The answers to these questions will be kept in strict confidence.
Are you currently taking medication for any physical or psychological condition?
Yes No
Do you have any chronic physical limitations or disabilities?
Yes No
Do you have a history of psychological or emotional illnesses, or issues?
Yes No
Do you have a communicable disease?
Yes No
Have you had a serious illness or major surgery within the last five years?
Yes No
Are you currently pregnant or trying to become pregnant?
Yes No
If you answered YES to any of the above questions, please provide us with more relevant details as it would pertain to retreat safety. As well, please describe if there is anything else you feel we should know about you OR with regards to your participation in the program here:
Message * :
refresh
By submitting this Application form, you agree to the Terms & Conditions of participation

International Affiliations

Yoga Alliance