NEW YEARS EVE CELEBRATION 
31st December 2023
6:00pm-1:00am
Evening Program Only - No Overnight Stay
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電子郵件 *
PERSONAL DETAILS

Name
*
Spiritual name (optional)
Date of Birth *
MM
/
DD
/
YYYY
Gender (accommodation is single gender) *
Mobile Number *
Physical Address & Postal Address (if different) *
Emergency Contact Details (Name, relation to you, contact details) *
Do you have yoga experience? Please details *
GENERAL HEALTH INFORMATION

Please tick if you have had (in last 5yrs) or have any of the following conditions and provide details below:

*
必填
INJURIES 
Do you have any current or past injuries that may impact on your ability to participate in various practices? 

(ex: A hip issue that does not allow you to sit comfortably in meditation.)

Our teachers will provide alternatives and modifications to the best of their ability to help accommodate your needs*. 
*

ADVICE

*If you have ticked any of the conditions above, you should check with your doctor for clearance before commencing your stay at Anahata. You must be comfortable and pain-free throughout all activities and remain within your personal limitations. If you experience pain or discomfort in any of the practices or daily activities, stop and seek advice.


*
必填
DRUG & ALCOHOL POLICY 
Smoking/vaping, alcohol, and recreational drugs are not permitted on Anahata property at any time. This includes being intoxicated or under the influence while on the property. 
*
必填

Additional Health Information 

Please provide any further relevant health information:

*
Are you taking any medication? 
If YES, please provide relevant information below. 
*
Current Medications:
Are you pregnant?
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If currently under the care of a Doctor or Health Professional for any condition, please provide information for your Health Care Provider:

Do you have any food allergies or medical dietary requirements?

Our kitchen is Vegetarian and we cater for gluten free, dairy free and vegan diets.

All meals are served "Family Style" and we do not cater for individual/personal preferences.

No meat is permitted on the property.
*
RETREAT FEES:
$50.00pp

20% Locals Discount for Golden Bay Residents.

PAYMENTS MUST BE MADE PRIOR TO ARRIVAL
Please include transport and bedding fees in your total payment.

Anahata Health and Education Trust Account

Bank: Westpac Bank, Takaka New Zealand
Account Name: Anahata Yoga Retreat
Bank Account: 03 17 11 – 0071037-00

International transfers
SWIFT Code / IBAN number: WPACNZ2W
Westpac Phone/Fax: +64 (3) 5258094/8957

Paypal
yoga@anahata-retreat.org.nz


Please ensure when doing an Internet transfer that you include your NAME on the transfer and specify ‘NYEC’ in the reference. (Some banks do not allow letters as a reference; you can use your phone number instead).

Please provide proof of payment. Your space is only considered confirmed upon receipt  of full payment.

*
必填
STATEMENT *
必填
Have you stayed at Anahata before?
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How did you find out about Anahata?  *
必填
系統會透過電子郵件將你的作答內容複本傳送到你所提供的地址。
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