2019 Retreat booking form Viveka Gardens

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Om! We're looking forward to hosting you at Viveka Gardens. Please complete this form and then contact us to arrange payment (see the end of the form). This information is for contractual purposes and for emergency and health reasons. It will be retained for 2 years on the google cloud and then deleted. Please see the Privacy Policy published on vivekagardens.com for more information and how to opt out. See you soon. Om Shanti.

Email *

name *

Which retreat would you like to attend?

address *

email *

mobile *

landline *

emergency contact name and relationship to you *

emergency contact email, mobile and/or landline (by putting this info here it is assumed you have obtained their consent) *

previous yoga experience (briefly) *

what do you hope to gain from the retreat? (briefly) *

Can you offer or would you like a lift? Where are you coming from? Fiona will try to match for lift sharing.

Please let us know if you are affected by any of these. Please be in touch if you'd like to talk it over. *

heart condition

diabetes/glaucoma

neck or back injury

osteoporosis

recent major surgery

childbirth in the last 12 months

depression, grief

mental health condition (optional disclosure)

could be pregnant

no health condition

Other:

Please give details or add anything else you think we should know about. *

Please tell us about any food allergies (write 'none', if none) *

Payment in full required on booking. If you can't make it for some reason the retreat fee is transferable to another retreat up to 3 weeks before the retreat start (£11 admin fee). You are also welcome to transfer your place to a friend (£11 admin fee). Cancellation refund possible (minus 20%) if we are able to fill your space up to three weeks before the retreat. Should we have to cancel the workshop you will be refunded in full but we cannot pay for any travel you may have bought.

internet banking FJ Law 090132 48396382 and put your name as reference

cheque payable to Fiona Law in advance in person or by post to Viveka Gardens, West Leigh, Crediton EX17 6BL

cash in person paid IN ADVANCE

paypal to fiona.law@hotmail.co.uk (PLEASE ADD 5%, £2.50 on day retreats, £13.00 on weekend retreats)

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Please confirm you have read the retreat information, rules, Ts & Cs, http://vivekagardens.com/retreat-information-rules-ts-cs/, and are happy to go along with this. 'Sign' by typing your name and date

I agree to take full responsibility for myself and for my personal property. The decision to participate in the activities is my own responsibility. In addition I agree that I will not hold Viveka Gardens responsible for any injuries or damages that might result from my participation in any of the activities. 'Sign' by typing your name and date

Thank you. Now please LET US KNOW you have completed the form and sent payment, using this email, fiona.law{at}hotmail.co.uk. See you soon. Om Shanti.

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