Lisa Dunn Yoga and Gin and Yin Retreats Sri Lanka Booking Form & Health Questionnaire
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Email *
Name *
Address *
Phone Number *
Date of Birth *
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At what level is your yoga practice? *
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Which type of room would you prefer? All prices per person *
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Would you require an airport transfer on arrival?  We include a transfer for flights arriving on the below flight or a similar arrival time at Colombo Airport *
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To meet the Sri Lankan Airlines flight UL 504 - landing into Bandaranaike Int. Airport Colombo at 12.35 on Saturday 24th Feb

Check-in is from 3 pm on Saturday 24th Feb at Sri Devi Retreat, Habaraduwa Road, Unawatuna, Sri Lanka.  
Are you traveling alone or do you know who you wish to share with?
If travelling with a friend what is their name?
Do you or have you suffered with a heart condition? *
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If you answered yes please add details
Do you feel pain in your chest during physical activity? *
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If you answered yes please add details
Have you had chest pain in the last month when not doing physical activity? *
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If you answered yes please add details
Do you ever lose consciousness or do you lose your balance because of dizziness? *
If you answered yes please add details
Do you have a joint or bone problem that may be made worse by a change in physical activity? *
If you answered yes please add details
Are you currently taking any prescription medication for blood pressure or heart condition? *
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If you answered yes please add details
Are you pregnant? *
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If you answered yes please add details
Do you have insulin dependent diabetes? *
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If you answered yes please add details
Do you know of any other reason you should not exercise or increase your physical activity? *
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If you answered yes please add details
Do you have any food allergies or dietary requirements? *
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If you answered yes please add details
How did you hear about this retreat?
I hereby agree to indemnify and hold harmless L Dunn (Lisa Dunn Global Retreats) and R Clougherty (Gin and Yin Retreats) 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.
I agree *
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Payment Terms & Conditions:  A deposit of £400, non-refundable, is required to secure your booking, with the full balance to be paid by 20th January 2024. Payment instalments are also an option Get in touch with us for further info.  Lisa - lisa@lisadunnyoga.com or Ruth -  hello@ginandyinretreats.com Cancellations:  Whilst we wish to treat cancellations sympathetically, spaces are limited and the following charge must apply. Cancellation for your holiday, for whatever reason, should be notified to us directly in writing:- Full Payments: For places paid in full and then cancelled the following applies:- More than twelve weeks before the start of the retreat: 100% refund minus the deposit.- eight-twelve weeks before the start of the retreat: 50% refund minus the deposit.- Less than eight weeks before the start of the retreat no refund can be given.                                                                                                                              Travel Insurance. We strongly advise that you take out travel insurance that will cover you financially, not only for unforeseen events that may occur whilst on holiday but also in the event of you needing to cancel.
I agree *
Required
For deposit and full payment please transfer funds to the bank details below using the reference - Sri Lanka Retreat. to Lisa Dunn - Sort Code: 23-14-70 - Account Number: 66089515 IBAN GB37 TRWI 2314 7066 0895 15
A copy of your responses will be emailed to the address you provided.
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