Way of Nature Journey for Women

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June 4th-7th 2021

Name *

Email *

Mobile Phone Number: *

Name of Next of Kin and Telephone Number: *

Your Organization (if any)

Where Did You Hear About Us?

How are you planning to arrive and depart to the programme? *

Dietary restrictions *

None

Vegetarian

Vegan

Kosher

Gluten-free

Other:

Do you suffer from any of the following conditions? *

Asthma

Chest Problems

Fainting

Heart Troubles

Tuberculosis

Bronchitis

Diabetes

Migraines

Raised Blood Pressure

Angina

If you answered ‘yes’ to any of the above, please provide accurate details below:

Other:

Required

Do you suffer from epilepsy? *

Yes

If yes, please write below A) What specific epilepsy syndrome have you been diagnosed with and any patterns

Other:

Do you suffer from any other condition requiring that we should be aware of including previous injuries, medical treatment and medication? *

Yes

If yes, please provide accurate details below:

Other:

Are you allergic or sensitive to any medication (e.g. Penicillin), insect bites or food? *

Yes

If yes, please provide accurate details below:

Other:

Are you taking any form of medication on a regular basis? (If so please ensure that you have adequate supplies of medication for your entire visit) *

Yes

If yes, please provide accurate details below:

Other:

To the best of your knowledge, have you been in contact with any contagious or infectious diseases, or suffered any recent condition that may become infectious or contagious? *

Yes

If yes, please provide accurate details below:

Other:

Please provide any additional appropriate information concerning your health: *

In order to participate in a Way of Nature Programme it's essential that you have read through and agreed with our Terms and Conditions that you can view here: http://bit.ly/2g9r7Zu. Please take some time to read through it. Cancellations due to Covid: *If you need to cancel due to Covid: We can accept a cancellation up to 72 hours before the programme starts and would ask for a positive test result as confirmation. With this we can give a 50% refund. * We will do our utmost to deliver the service in accordance with what we have confirmed to you. In reserving the right to make unavoidable cancellation due to Covid we will reimburse at least 50%, depending on the costs incurred.

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By clicking 'Yes' below you confirm that you have read through and understood the Terms and Conditions agreement between yourself and Way of Nature UK Ltd. *

Yes

Required

We have a lot of interest in this programme which is wonderful but we hope to keep it small and intimate, also due to Covid. Therefore if you would like to join, please secure your place with the payment (latest by May 16 2021). Use your last name as your reference when paying into the bank account below and drop us a quick note (to din@grounding.business) when you have made the transfer: Bank name: Co-operative bank Account name: Way of Nature Ltd Sort code: 089299 Account: 69683358 BIC: CPBKGB22 IBAN: GB27CPBK08929969683358

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