Mercy of the Womb Booking Form
Full Name *
Your answer
Age *
Your answer
Mobile Number *
Your answer
Contact Address *
Your answer
Emergency Contact Name and relation *
Your answer
Emergency Contact Number *
Your answer
Ethical background ( This helps us to create an inclusive and diverse space that embraces and accommodates different aspects of the Muslim Community) *
Your answer
Do you have any medical conditions ( Please mention details below) *
Your answer
Do you have any allergies/ specific dietary requirements? ( If yes, please mention below) *
Your answer
Doctor Name and address *
Your answer
A little about your relationship with your womb/ menstruation. (This information will not be shared but it helps us to tailor some of the conversations, discussions and advice given in the group) *
Your answer
How did you hear about the retreat? *
Your answer
I am able to attend the entirety of the retreat from Friday 28th February ( 13:00) till Sunday 1st March ( 16:00) *
Please note by submitting this form you are committing to attending the full retreat and paying the deposit by the 27th January and the remaining amount by 10th February. You have also read the FAQs and agree to the Code of Conduct. You also understand the refund policy. If you have any issues or concerns please do email us at therabbaniproject@hotmail.co.uk. *
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