New Year Yoga Retreat Booking Form

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New Year Yoga Retreat, Shekina Yoga Retreat, Glastonbury, UK
Booking Form

* Indicates required field

Full Name *

Retreat Date *

30th Dec '19 - 1st Jan '20

Email *

Mobile Phone Number *

Sex *

Male Female

Emergency Contact *

Name/Relationship of Emergency Contact *

Are you driving & willing to car share? *

Yes No

Yoga Experience *

Complete Beginner Have practiced a little yoga Practice regularly Intermediate Yoga Teacher

What style of Yoga do you practice (if known) *

Hatha Yoga Sivananda Ashtanga Iyengar Kundalini Other

Do you have a Meditation practice? *

Yes, regularly Yes, occasionally No

Do you need to borrow a yoga mat? *

Yes please No, I have my own mat

Please let us know of any medical problems or medication *

Please include any old injuries, recent surgery, if you have heart problems, high or low blood pressure. Are you taking medication?

Are you pregnant? *

No Yes

Do you have any food intolerance or foods that you can not eat? All meals are Vegan *

Meals on our Yoga Retreat are all vegetarian

Accommodation (Prices are per person. All accommodation is shared. Please contact us for single occupancy, triple requests) *

5 bed cabin - unisex dorm - £260 Twin cabin - £280 Twin Shared Room - £290 Double/Triple shared room - £290 Double/Triple ensuite - £310 Single - Unidome - £290

Payment Amount *

I would like to pay in full I would like to pay 50% deposit

Payment Options (please contact us if you need to pay in installments) *

Bank Transfer -Miss C Conway, A/C 44177860 sort 30-62-96 (LLoyds Bank). Please put your name as a reference when sending payment. Paypal - email - [email protected] (any paypal charges incurred will be added to cost of retreat)

If you would like to share a room with a friend, what is their name? *

How did you hear about the Retreat? *

Additional Information *

All information provided will remain confidential and used only for Yoga Retreat purposes. Please be advised a 50% deposit secures your place. Any remaining balance must be paid by Wed 5th Dec'19. Deposits are non-refundable. We cannot refund, credit or transfer any balance within 4 weeks of retreat start date or once the retreat has started. We really look forward to sharing the weekend with you! *

I understand my own body’s challenges and take full responsibility for my own practice *

Agree

If you are unsure about practicing yoga due to a medical complaint, please consult your medical practitioner or doctor

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New Year Yoga Retreat, Shekina Yoga Retreat, Glastonbury, UK Booking Form

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New Year Yoga Retreat, Shekina Yoga Retreat, Glastonbury, UK
Booking Form