Awakening Feminine – Bali Retreat Registration Form

Name *

First

Last

Address

Email *

Mobile phone number *

Date of Birth *

Emergency Contact - name, email, mobile and address *

Level of Yoga experience

Do you have any current injuries? If yes please list *

Do you have any current health issues? If yes please list *

Do you suffer from any Mental health issues? If yes please let us know *

Are you taking any medications? Please list *

Do you suffer from any allergies? If yes please list *

Do you have any food allergies/aversions? *

Do you follow a specific diet? Vegan, Gluten Free etc? *

What drew you to this Retreat and how did you hear about it? *

What are some of the challenges you are facing that you are really struggling with? *

What experiences or tools are you specifically hoping to get out of this retreat? *

What would you love to get out of this retreat? *

Do you snore?

Are you willing to be moderate in your use of electronics during our retreat? *

What made you say yes to this experience and to yourself? *

Is there anything else you would like us to know?

Release form - I agree that by submitting my name and the date below, this hereby constitutes my signature and agreeance to the below release form

Release Form: I understand that I am solely responsible for my health and safety, and will not hold retreat leaders responsible for any loss, injuries, or illness that may occur. I will consider the interests of the group, but know that I may participate in as many or as few of the activities as I like. Please note: To insure a safe and sacred a space, we do not allow alcohol at the retreat center itself. Thank you for understanding and agreeing.