Coming Home to Stillness Retreat
Personal and health information questionnaire
Name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Mobile number *
Your answer
Email *
Your answer
Address *
Your answer
Current injuries, illnesses, mental health or medical conditions including any currently managed by medication *
Your answer
Allergies, food and/or others *
Your answer
Dietary Requirements *
Your answer
Experience with yoga and/or meditation. Please indicate duration and style of practice *
Your answer
Reason for retreat. What do you hope to get out of participation *
Your answer
Additional requests or requirements
Your answer
Room Selection *
Terms and Conditions
Financial:
A non refundable deposit of $500 is required to secure your booking
The remainder of the fee must be paid before the 10th of July
Cancellations must be given in writing prior to the 10th of July, otherwise all fees will be forfeited
Cancellations made before the 10th of July will be eligible for full payment refund less deposit amount.
The retreat requires a minimum number to run. Should this minimum not be reached, the retreat will be cancelled and all payment, including the deposit, will be fully refunded
Home of Equanimity reserves the right to cancel the retreat where all payment, including the deposit, will be fully refunded

Pre-Retreat requirements:
All bookings must be made with a health and personal questionnaire filled out
Participants are responsible for their own wellbeing and assert upon booking that they are medically fit for general exercise and will take caution not to strain or injure themselves while participating in the retreat

Agreement *
Required
Payment
Please make payment either in person or via Bank Transfer to the following account:

Name: Han Wee Tan
BSB: 013600
ACC: 189224197

Thank you for booking into the retreat! A confirmation email will be sent out to you. Please keep an eye out for it in your junk folder.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy