Registration Form - The Shala Bali Retreat / Rituals for Self.

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The following information will enable your instructors and therapists to offer you the safest and most appropriate yoga postures and treatments for your current level of health. This form must be signed in order to complete your registration.

All information given on this form will be treated as confidential.

Email *

MY IDENTITY

Last Name *

First Name *

Date of Birth *

YYYY

Place of Birth *

Address (including zip and country) *

Nationality *

Passport number *

Passport expiry date *

Phone number *

Email *

In an emergency, please call

First and last name *

Family connection *

Phone number *

Email *

MY BOOKING

I would like to book for the 'SHALA BALI RETREAT ~ Rituals for Self.' from MONDAY 18th of MARCH until SATURDAY 23rd of MARCH, 2024.

MY ROOM OPTION *

If your chosen room is already booked, we will get back to you shortly providing another option.

VILLA SHARED TWIN ROOMS - Ensuite Bathroom

VILLA PRIVATE SINGLE ROOMS - Ensuite Bathroom

Required

I would like to share my room with (first and last name)

NOURISHMENT

We are delighted to work with talented chefs who will create a vegan menu for you. You can optionally add the following option :

Gluten-Free

Do you have any food allergies or do you follow a special diet? If yes, please specify *

YOGA

We choose Yoga as a way of life and we are committed to promoting the physical, emotional, mental and spiritual well-being of our guests. The following information will be very useful to us.

Have you practiced Yoga before? If yes, what style, for how long and how often? *

Are there any specific areas that you would like to explore or deepen within your practice? *

ADDITIONAL TREATMENTS

We have already included offerings, tours and activities in the price of the retreat to take you around and discover the beautiful surroundings. Nevertheless, we give you an opportunity to customize your retreat with extra wellness treatments and healing sessions.

Our treatments are tailored to support your individual needs and health goals.

The following offerings just below are not included in the price of the Retreat and will be paid prior to the start.

I already know that I would like to book : *

REIKI HEALING - 60 minutes

FACE SCULPT - 60 minutes

LYMPH SCULPT - 60 minutes

SOUND HEALING at Pyramids of Chi

I don't know yet..

I do NOT wish to add any other activities.

MY HEALTH

Have you ever had or do you have any of the following : *

Yes

Diabetes

Asthma

Repetitive Strain Injury (RSI)

Epilepsy

Cramps

Muscular pain

Cancer

Skin sensitivities

Headaches/migraines

Blood clots

If yes to any of the above, please explain : *

Are you, or do think that you are pregnant? If yes, then in what stage of your pregnancy are you? *

Do you have a regular cycle?

If yes, do you know where in your cycle you will be during the retreat? Menstruating, Ovulating, Neither, Not Sure.

Have you had any surgery in the past 12 months? If yes, please specify : *

Do you have any other known health conditions or injuries, past or present, which may cause you difficulty or pain? If yes, please specify: *

Are you currently on any medication ? If yes, please specify *

Is there anything else you need to tell us about your physical or mental conditions that may affect your performance or put you at risk during the Retreat? *

Are you on any medication for or have had past experience of depression, anxiety or other mental illness, past or present? *

I understand that the instructions given throughout the week are intended as guidance only, and that I do not need to perform any particular pose or movement I am not comfortable with. *

I have read the Terms and Conditions

I have received all the necessary information in regards to the retreat, the meals, the accommodation, the location etc.

I state that the information I have provided on this form is true and correct.

Required

We would like to thank you for your interest in our Retreat.

Once we have received your form, we will contact you by email to follow the steps to definitively validate your registration.

A non-refundable $500 USD deposit is required to confirm your place and the remaining amount is due by February 1st, 2024.

The Early Bird offer is only valid until December 1st, 2023.

A copy of your responses will be emailed to the address you provided.

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