Intouch Yoga Retreats with Flo Fenton Registration Form

Dear students, for the safety and maximum benefit of yourself and others on the retreat, please answer the following questions briefly but honestly. Many thanks.

Name

*

Age

Email

*

Retreat Name

*

Retreat Date

*

Occupation

Phone Number

*

Mobile Number

Dietary Requirements or Allergies

Accommodation

Previous Yoga Experience

Medical Conditions or Recent Surgery

Are you currently on any medication, or taking or withdrawing from any kind of meds/drugs?

Do you have any history of mental illness?

What would you most like to get out of the retreat?

Emergency home contact details (next of kin):

*

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