Summer Convergence 2013

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

An acrobatics, healing arts and yoga collaboration
Dates: 3rd August -11th August 2013
Location: Wytwornia Ciszy, Uniejow, Poland

I hope you are as excited as we are about this gathering.

Please complete the following questions for our records as it will help ensure our time together will be mutually beneficial.

First Name *

Surname *

Email Address *

Contact Telephone Number (include 00/+ and country code) *

Emergency Contact Details *

Please provide a name and their contact details in case of an emergency

Give a brief summary of your experience of acrobatics

Please give details of what you are working on or would like to work on during the retreat

Give a brief summary of your experience of healing arts

Please give details of what you are working on or would like to work on during the retreat

Give a brief summary of your experience of yoga

Please give details of what you are working on or would like to work on during the retreat

Please list any dietary needs

For example: gluten free, dairy free or nuts allergies.

Are there any medical conditions or injuries that we may need to be aware of ?

Please list five unique things about yourself

Please use this space to add any further information about yourself

Declaration - I understand that the instructions given throughout the retreat are intended as guidance only and agree to adjust my practice according to my needs and abilities, to call on additional support and advice (including spotting) from the teachers whenever needed. I will act responsibly and will be attentive to my own safety and the safety of others during retreat *

By ticking this box, I confirm that I have read and understand this declaration.

Required

Submit

Clear form

Never submit passwords through Google Forms.

Forms

This content is neither created nor endorsed by Google.