A Heartful Retreat in Nature

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Friday 8th to Sunday 10th October at the Quadrangle, Kent

What is your name? *

What is your email address? *

What is your phone number? *

What is the name of your emergency contact? *

What is the phone number of your emergency contact? *

What do you hope to gain from this retreat? *

Have you practiced yoga before? *

Yes

If yes, what is your preferred style? (style, tempo, time of practice, etc)

How is your general health and wellbeing? (this can cover physical, emotional, mental and/or spiritual aspects) *

Have you suffered from any of the following? (please check any/all that apply)

High blood pressure

Low blood pressure

Chest complaints

Heart trouble

Hiatus hernia

Asthma

Epilepsy

Back trouble

Eye or ear trouble

Migraine

Arthritis

Persistent pain anywhere in your body

Previous/Recent operations

Any recurring disease or injury

Please give a brief description below (if you checked any boxes above, or have anything else to include)

Are you pregnant *

Yes

Have you recently given birth? *

Yes

Are there any aspects of your health you would like to share? (if so please give a brief description below)

Is there anything else you would like us to know about you? (if so please give a brief description below)

If you have any special dietary requirements please give details below (the food will be locally sourced, plant based and vegetarian - may include nuts, eggs and dairy)

On what basis would you like to join the retreat? Please contact Katy directly if you would like a concession space. *

£190 concession dorm or camping

£240 standard dorm or camping

£280 supportive dorm or camping

£280 standard shared twin room

£340 supportive shared twin room

£290 concession private room

£340 standard private room

£390 supportive private room

How did you hear about the retreat? (email mailout, social media, word of mouth, friend, etc) *

Making your deposit payment

Thank you for completing this form.

If you haven't already done so, please make your 50% deposit payment by bank transfer with your name as the payment reference.

Katy Cara, Monzo Bank
https://monzo.me/katycara

Sort code 040004
Account 38733593
Reference: your name

Please notify us by email when you have made your payment.

We'll be in contact with you soon.

In the meanwhile, please add katy@mahayoga.org.uk to your email safe list, and if you have any questions please feel free to contact us.

We look forward to being with you at the retreat. With love from Katy and Mela

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