Italy Yoga Retreat Questionnaire
Thank you for signing up for our Yoga Retreat in Tuscany, Italy
Which style(s) of Yoga would you prefer to practice at the retreat?
Gentle (Yin and Restorative)
Moderate (Flow with Yin and Yang poses)
Vigorous (Dynamic Flow- sun salutations)
What would you like to receive from your experience at this retreat?
Do you have any of the following health or medical conditions?
High Blood Pressure
Low Blood Pressure
Carpal Tunnel Syndrone
Neck or Spine Injury
Elaborate if needed or if there are any other health concerns?
Please list any food allergies, sensitivities or preferences.
The cost is $950 plus tax. We require a $100 non refundable deposit upon registration. How would you like to make payment?
A $100 non-refundable deposit is required upon registration to secure your spot.
Cheque (payable to Nienke Young)
Credit Card (at studio)
Interac e-transfer to
I recognize that it is my responsibility to consult with my doctor, if I have a medical condition, prior to starting an exercise program. I realize that it is my responsibility to notify my instructor of any serious illness or injury before every class. I understand that these classes involve physical activity and even with the best of intentions it is possible that injuries may result or prior conditions may be aggravated. If at any time during the class, I experience discomfort or strain, I will listen to my body and rest.
I freely accept and assume full responsibility for any and all injury, harm or loss whatsoever arising or resulting from my participation in these classes. I hereby release the instructor and the retreat center from any and all liability for any injury, harm, damage, loss or consequential loss or damage that I may undergo arising or resulting from participation in these classes. I agree to waive any and all claims of any nature or kind whatsoever that I or my heirs, executors, estate trustees, administrators, assigns or representatives have or may have in the future against the instructor and the retreat center.
PLEASE READ STATEMENT ABOVE AND TYPE YOUR NAME TO APPROVE
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