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Yoga

Health Questionnaire

Important: Please complete this questionnaire accurately and honestly. All information will be kept confidential and used to ensure your safety and well-being during the retreat.

Emergency Contact

Health History

Have you practiced yoga before?
Are you currently under medical treatment for any condition?

If yes, please specify the condition(s) and treatment: 

Have you had any recent surgeries (within the past year)?
Do you have any of the following conditions? (Check all that apply)
Have you ever experienced any of the following symptoms during or after physical activity?
Are you currently taking any medications?
Are you pregnant or have you given birth within the last six months?
How would you describe your current level of physical fitness?

LIABILITY WAIVER & INFORMED CONSENT

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I confirm that I have read and understood the above questions. I acknowledge that I am responsible for consulting with my healthcare provider regarding my ability to participate in the yoga and wellness activities offered during this retreat.
I further acknowledge and consent being involved in physical activities where there is risk of accident or injury and will take full financial responsibility for any loss or injuries. 
I hereby release the organizers, the venue and the instructors of this retreat from any liability related to my participation, provided that reasonable care has been taken.​

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All information given to the organisers is completely private and confidential.

Please submit the form to confirm that you have agreed to participate in the sessions that are part of the program, that you understand the risks involved and understand that you can withdraw at any time.

Thank you for submitting. See you soon!

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