Revive (& Run) Retreat Portugal, with Helen Clare at Monte Velho
21-27 April 2019
Name *
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Age *
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Address *
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Phone *
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Tell me about your yoga experience *
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Which type of room would you prefer? *
Which currency are you paying in? *
Please name anyone you wish to share with, including twin or double set up if applicable. *
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Do you or have you suffered with a heart condition? *
Do you feel pain in your chest during physical activity? *
Have you had chest pain in the last month when not doing physical activity? *
Do you ever lose consciousness or do you lose your balance because of dizziness? *
Do you have a joint or bone problem that may be made worse by a change in physical activity? *
Are you currently taking any prescription medication for blood pressure or heart condition? *
Are you pregnant? *
Do you have insulin dependant diabetes? *
Are you 69 years of age or older? *
Do you know of any other reason you should not exercise or increase your physical activity? OR, any further health information to give: *
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All the food provided will be plant-based and whole food, and organic and local as much as possible. Do you suffer with any food allergies and/or have any dietary requirements? *
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How did you hear about this retreat? *
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GDPR: I would like to be able to contact you with further information regarding this retreat, and future retreats, by adding you to my mailing list. You can unsubscribe from my emails at any time. I respect your privacy and do not share your information with any third parties without your consent. *
I hereby agree to indemnify and hold harmless H Clare from and against liability, damages, costs, loss or expense (including without limitation, legal fees) arising out of any bodily injury, at any time sustained by the undersigned. Yoga is no substitute for medical diagnosis and treatment; that yoga practice and/or specific poses are not recommended for individuals with certain conditions (e.g., cardiac illness, later stages of pregnancy, post-surgery); and that the student assumes the risk of yoga practice and releases the teacher and studio from any liability claims. *
Payment Terms & Conditions: A non-refundable deposit is required to secure your place, the remainder is due no later than 8 weeks before the start of the retreat, for which you will receive an invoice. If payment is not received 8 weeks prior, your place will be offered to another. In the event of cancellation: 60 days or more prior to the retreat: Your entire payment will be refunded, less £/€250 which is your deposit. 59-30 days prior to the retreat: Payments are not refundable, but are transferable (less £/€250 deposit) to a future retreat. 29 days or less prior to the retreat: Payments are not refundable. *
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