Chilworth Manor Retreat Form | Gemyogaandwellness

Chilworth Manor
Retreat Registration Form

We're thrilled you want to RETREAT with us! Please complete the form below so we can be sure to provide you with a wonderful retreat...

Name

Phone

Please give an emergancy contact name & number:

How did you hear about this retreat?

Have you practised yoga before? If so, for how long?

Do you have any injuries or health concerns? This incluces recent surgeries. If so, please provide details:

If you are pregnant, have high or low blood pressure or have a detached retina, please state here so we can discuss beforehand.

Do you experience any of the following? Neck & shouder tension / back ache / difficulty sleeping / stress / anxiety / depression?

Do you suffer from any hearing issues or loss?

Catering Needs: As there will be food & drink provided on your retreat, please state if you have any allergies, dietary requirements, or anything you just won't eat!

If you select massage, please state if you take any medications & what they are:

Your Personal Needs: Feel free to tell us what you'd like to get out of your day or how you would like to feel. Do you require anything to bring more comfort to you during yoga & sound healing? Are you going through something sensitive that we need to be aware of?

I agree that any information, instruction or advice from Gem Yoga & Wellness may NOT be used as a substitute for my Doctor's advice or treatment. I understand that I should consult my doctor before starting a new exercise programme and stop immediately if I feel unwell, or any pain or discomfort.

Tick to recieve emails about yoga classes, events or retreats from Gem Yoga & Wellness

Tick to recieve emails about sound healing events with Lisa from Natural Energy Healing

Tick to recieve emails about treatments & offers from SLS Medispa

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Thank you for submitting!

Chilworth Manor
Retreat Registration Form

Fancy some Free yoga?

Storytelling

FAQ's

Chilworth Manor Retreat Registration Form

Fancy some Free yoga?

Storytelling

FAQ's

Chilworth Manor
Retreat Registration Form