Name *

First Name

Last Name

Phone *

(###)

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We offer a vegetarian diet while on retreat. Do you have a severe food allergy, any sensitivities or a medically diagnosed intolerance of any kind?: *

Yes

No

Have you practiced mindfulness, yoga asanas (physical practice) and sound meditation before? *

Yes

No

Are you currently taking any medicines or receiving any medical treatment? *

Yes

No

Please tick if any of the below applies: *

Have you had any recent operations or illnesses?

Muscular / Skeletal

Respiratory

Reproductive

Circulatory

Digestive

Nervous system

None of the above applies

Waiver of Liability and Informed Consent Release for Yoga, Meditation and Sound Healing practices on retreats with Amanda Denton and David Ramcharran. *

By ticking this box I confirm to the waiver of liability and consent release.