A Heartful Retreat in Nature
Monday 28th to Wednesday 30th June at the Quadrangle, Kent
What is your name?
What is your email address?
What is your phone number?
What is the name of your emergency contact?
What is the phone number of your emergency contact?
What do you hope to gain from this retreat?
Have you practiced yoga before?
If yes, what is your preferred style? (style, tempo, time of practice, etc)
How is your general health and wellbeing? (this can cover physical, emotional, mental and/or spiritual aspects)
Have you suffered from any of the following? (please check any/all that apply)
High blood pressure
Low blood pressure
Eye or ear trouble
Persistent pain anywhere in your body
Any recurring disease or injury
Please give a brief description below (if you checked any boxes above, or have anything else to include)
Are you pregnant
Have you recently given birth?
If you have recently given birth, are there any aspects of your pregnancy, birth and/or postpartum journey you would like to share? (if so please give a brief description below - you will also have the opportunity to share in more detail at the retreat with relevant members of the team)
Are there any other aspects of your health you would like to share? (if so please give a brief description below)
Is there anything else you would like us to know about you? (if so please give a brief description below)
If you have any special dietary requirements please give details below (the food will be free range vegetarian - may include nuts, eggs and dairy)
On what basis would you like to join the retreat? Please contact Katy directly if you would like a concession space.
£180 - £200 concession camping - own tent or campervan
£210 - £240 standard camping - own tent or campervan
£250 - £300 supportive camping - own tent or campervan
£210 - £240 concession dorm
£250 - £280 standard dorm
£290 - £340 supportive dorm
£290 - £330 standard shared twin room or bell tent
£350 - £390 supportive shared twin room or bell tent
£350 - £390 standard private room or bell tent
£400 - £450 supportive private room or bell tent
How did you hear about the retreat? (email mailout, social media, word of mouth, friend, etc)
Making your deposit payment
Thank you for completing this form.
If you haven't already done so, please make your 50% deposit payment by bank transfer with your name as the payment reference.
Sort code 236972
Reference: your name
Please notify us by email when you have made your payment.
We'll be in contact with you soon.
In the meanwhile, please add
to your email safe list, and if you have any questions please feel free to contact us.
We look forward to being with you at the retreat. With love from Katy, Mel, Holly and Joanne
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