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    Yoga for Trauma workshop, 8-10 July 2022

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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:


    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.

    After receiving confirmation of acceptance, we will send payment instructions.

    I have read the cancellation policy