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Participate In Retreat
Please fill out this form to provide details about your health condition before taking yoga classes.
Last name
Date birth
Contact number
Name and contact number of a loved one
Are you currently taking any medication?
select value
Yes
No
If yes, please write down the names of the medications and the reason for use
Do you have a history of any specific illness?
select value
Yes
No
Have you had surgery or hospitalization in the past 6 months?
select value
Yes
No
Do you have an allergy to any food, medication, or insect?
select value
Yes
No
Please write down the allergy items and symptoms of the reaction:
Do you have an EpiPen in case of an allergic reaction?
select value
Yes
No
Do you have a specific diet? (Vegan, vegetarian, gluten-free, etc.)
select value
Yes
No
If yes, please explain:
What is your level of ability in swimming?
I don't know how to swim.
Beginner
Almost good
Completely professional
Are you interested in participating in paddle boarding?
select value
Yes
No
Is there anything else the organizing team needs to know?
Submit form
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