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Yoga for Trauma and Stress

Your Name (required)

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Age (required)

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Your Email (required)

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Emergency Contact Number (i.e. friend or family member):

It is important that the workshop teacher is aware of any factors that may affect your practice. This will be kept strictly confidential and is to ensure that alternative practices or variations are given when appropriate.

Please indicate if you currently have or have had any of the following:

Heart condition YesNo

High or Low blood pressureYesNo

Spine or neck injury or condition YesNo

Diabetes YesNo

Epilepsy YesNo

Asthma YesNo

Bouts of dizziness YesNo

Hernia YesNo

Arthritis YesNo

Stroke YesNo

Depression YesNo

Anxiety YesNo

Panic attacks YesNo

Post-traumatic stress disorder YesNo

If ‘Yes’ to any of the above, please give details:

Do you take any form of regular exercise?

Do you have difficulty going to sleep or staying asleep through the night?

Any other medical conditions or anything else the teacher may need to know?

Have you had any surgery? If so, when and for what reason?

Are you taking any medication? Please list, indicating what the medication is for and say for how long you have been taking it.

Are you pregnant or have you given birth in the last 6 months?

Have you practised yoga and meditation before? What kind and for how long?

Do you have any food allergies?

If requesting to share room with someone in particular, include name below:

Children
For retreats with children's programme, price per child half of the full course fee.
Name(s) and age(s) of the child/children:

Do you have any additional questions?

How did you find out about this workshop?

Thank you for taking the time to fill in this form.

Payment:
After receiving confirmation of acceptance, you will be asked to transfer the enrolment fee via Paypal.

Cancellation policy:
For any cancellation until one month prior to the workshop, the fee will be returned, less 10% cancellation fee. After that the cancellation fee will be 30%.

I have read the cancellation policy