Retreat - APPLICATION FORM

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AWAKEN - SPIRITUAL LIVING YOGA RETREAT
2-6 NOVEMBER 2019
WITH KEENAN CRISP

In order for us to best serve each participant on the retreat, please answer the following questions. All answers will be kept strictly confidential.

All fields are required

Do you have any history of physical illness or any disabilities, which may significantly affect your yoga asana practice or sitting meditation?

Have you experienced - or been diagnosed with - any significant mental health issues e.g. depression, eating disorders, anxiety, drug/alcohol abuse in the last three years?

Please outline any medication for any physical or psychological condition that you use, may or will be using whilst on retreat

Please inform us of any allergies that you have.

Please inform us of any dietary requirements that you have.

Please inform us of anything else you feel we should be informed about. Eg pregnant, going through divorce, getting married, addicted to chocolate.

Accommodation Options

If twin share room, I choose to room with: (if known)

How did you hear about this retreat?

In case of Emergency contact:

Your airline, flight numbers and departure and arrival times (optional)

Thank you!

**All applications will be considered within one week of receiving them.