Registration for the weekend retreat 9-11/6
The following information is strictly for the confidential use of the retreat teacher, Susie Jones. Please answer these questions fully to enable her to guide you appropriately.
Please read about the retreat before signing up: https://yogaroots.be/weekend-retreat/
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Name *
Email address *
How did you hear about this retreat? *
Have you been on a retreat before (weekend or longer)? Please give details *
Have you already taken classes with Susie ?
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At the retreat centre there are a small number of single rooms, most rooms are doubles, there are some triples (all have single beds). Priority will be given to those who might need a single room for health reasons. Please indicate here your needs and preferences. Please note the registration fee for single occupancy is 180 euros, shared room is 150 euros.
If you are coming with somebody and would like to share a room please give their name here
The meals are healthy, vegetarian and cooked on-site. Do you have any specific dietary requirements or allergies?
We would like to organise car-sharing to and from the retreat centre in Dongelberg. Please indicate if you are potentially interested in this either as a driver or as one needing a ride.
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Do you have any history of physical illness or any disabilities, which may significantly affect your sitting, standing, or walking practice?
Have you ever been diagnosed with or experienced any significant mental health issues, e.g. depression, eating disorders, anxiety, trauma, addictions, drug/alcohol abuse? If yes, please give details of condition(s) and date(s). Please mention any medications currently being taken.
Describe any present circumstances that might place you under additional stress or may significantly affect your practice (e.g. loss, bereavement, relationship breakdown, etc.)
To support ourselves and each other during the retreat there will be periods of silence, and a request not to use electronic devices such as mobile phones during the weekend (unless there is an emergency).
Do you agree?
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The registration fee of 150 euros per person (sharing a room) and 180 euros (single room) covers the basic costs of renting the retreat centre for the weekend (room and all meals included).
None of this goes directly to Susie, so you are asked to make a financial contribution to our non-profit association Roots ASBL for the teachings and guidance she will offer during the retreat, and the organisation of the retreat.
Do you agree?

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Health safety: we request that participants do a quick test at home if they are experiencing any Covid symptoms prior to the retreat and to not come if they have tested positive.
Do you agree?
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Cancellation policy:
Before 30 April full refund minus 20 euros admin fee
Between 01/05 and 4/6 refund of 50 euros
After 5/6 there is no refund
Do you agree?
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Disclaimer: Do you agree to take full responsibility of your physical and mental health during the retreat? *
Is there any additional information you would like to convey to the teacher or any question ?
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