Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Participant Information
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
First and Last Name
*
Your answer
Date of Birth
Your answer
Country of Residence
*
Your answer
Do you currently have a routine physical practice (ie. jogging, sport, walking, dance, yoga, etc.)? Please describe.
*
Your answer
Tell us about your profession/work/role/calling.
Your answer
Experience with Kundalini Yoga and/or Pilates (none required)
*
Your answer
Tell us a bit about your own personal intentions for this retreat—a few words is enough.
*
Your answer
Please note any accessibility accommodations you require or things we should know about your health that might impact your well-being while on retreat.
*
Your answer
Are you comfortable with alcohol (beer/wine) being available at the retreat house?
Would you plan to drink wine/beer at dinner?
*
Your answer
Do you have any food allergies or intolerances? If so, please list
*
Your answer
Do you have any special dietary requirements (i.e vegetarian, vegan) or strong aversions to any foods (i.e. things you simply won't eat!).
*
Your answer
Do you have allergies or sensitives to incense or candles?
*
Your answer
Will you be able to bring your own yoga mat?
Yes
No
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Page 1 of 1
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
