Satvatove Wales - Registration Form (all workshops)

Please answer all of the following questions completely. Your answers will be kept confidential.

The information you provide here will enable our facilitators and staff to better support your participation. If during the workshop you find yourself feeling uncomfortable to an excessive degree, you should report this immediately to the facilitator or to a staff member

If you have questions about the appropriateness of your participation in this Satvatove course, please consult a trained professional.

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Email *
Name *
Date of Birth *
Mobile Number  *
Health Information (check all that apply)
Have you ever had or do you have: *
Required
Are you under a doctors care at this time? If 'Other', please explain *

Are you under the care of a mental health professional such as a psychiatrist or psychologist at this time? If 'Other', please explain

 *

Have you ever had a “nervous breakdown? If 'Other', please explain

 *

Are you taking prescribed medication?

If other, what, and for what disorder? 

 *

Have you ever been hospitalised for psychiatric care or for mental disorder? If 'Other', please explain

 *

Are you pregnant? If 'Other', please explain

 *

Do you have any physical limitation that you believe may be an obstacle to your participation in this Satvatove course?  If 'Other', please explain

 *

Emergency Contact and phone number

 *
Dietary Preferences - there will be a vegetarian meal provided each day by our chef. Please let us know if you have need Gluten Free (GF) or Vegan (Vg) or other restrictions (allergies) below:
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