FORM: TARA HILLS RETREAT REGISTRATION

Lisa Fabry and
Sarah Divine

Tara Hills Retreat Registration and Dietary Requirements Form

Please fill out this form and press SEND at the bottom of the page to submit.

All information is confidential. Only the two workshop hosts will see this information and it will be stored securely. If you feel more comfortable speaking to one of us in private about any of the questions, please contact us directly.

Name

Today's date

Date of birth

Address

Phone number

Occupation

Emergency contact

Other practitioners you see

What are your three main health and wellbeing goals?

Yoga / Qigong experience

Do you currently have any kind of meditation or self-reflection practice?

Equipment - mats, meditation cushions and blankets are provided. If you are able to bring your own bolster, please indicate here.

PERSONAL HEALTH HISTORY

PLEASE DESCRIBE ANY HEALTH ISSUES YOU CURRENTLY HAVE

Please also complete the self-evaluative 'Adult Pre-Exercise Screening Tool' that we have sent you.

Digestion

Energy and Immunity

Breath

Heart

Urinary

Skin

Músculo-skeletal

Pain

Headaches

Mental health

Sleep

Any other health issues

DIETARY REQUIREMENTS

All meals on retreat are home-made, plant-based, gluten-free, made with wholefoods and using organic produce where possible. Some dairy products (eggs, yogurt and milk) will be provided.

OTHER INFORMATION

Please list any medication you take including prescribed drugs, over-the-counter medicines and supplements.

Do you have any known allergies or sensitivities?

Is there anything else you would like us to know to ensure that your retreat is a wonderful experience?

Lisa Fabry and Sarah Divine

Tara Hills Retreat Registration and Dietary Requirements Form

lisa@lisafabry.com

Lisa Fabry and
Sarah Divine