JANUARY 2017 - REBOOT CAMP
Reg Form
Email address
YOGA & AYURVEDA SCIENCES FOR ADVANCE HEALING
FULL NAME (AS PER RECORDS - DOCUMENT REQUIRED AT SITE)
BIRTH DATE
MM
/
DD
/
YYYY
E-MAIL ADDRESS
MOBILE NUMBER:
HAVE YOU PRACTICED YOGA BEFORE?
Required
HAVE YOU ATTENDED ANY YOGA-AYURVEDA CAMPS BEFORE?
DO YOU HAVE ANY ACTIVE OR PAST INJURY WHICH CAN BE A PHYSICAL LIMITATION?
ARE YOU UNDERGOING ANY TREATMENT OR MEDICATION?
WERE YOU IN THE PAST REQUIRED TO UNDERGO ANY PROLONGED TREATMENT OR MEDICATION?
IF YES (FOR ABOVE QUESTION) PLEASE GIVE A SMALL BRIEF
ARE YOU A HABITUAL SMOKER OR CONSUME ALCOHOL OR ANY TOBACCO SUBSTANCES?
DO YOU AGREE ABSTAINING (NON CONSUMPTION) FROM SMOKING, DRINKING, ANY PHYSICAL CONTACT (& OTHER TOBACCO SUBSTANCES) DURING THE CAMP?
A copy of your responses will be emailed to the address you provided.
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