"*" indicates required fields RETREAT GUEST INFORMATION FORMPlease complete this form so we can plan in advance to meet your needs. We’d like to know why you’ve booked with us so we can create a great retreat experience for you. We also need to be sure there are no medical conditions that will prevent you from enjoying your time with us. Reclaim Yourself is registered as a Data Controller with the ICO. Your personal data is treated in complete confidence and is protected according to the Data Protection Act/GDPR.1. ABOUT YOUName as in passport* First Last Nationality*Date of Birth* Day Month Year Email* Mobile number with country dialling code*Emergency contact name (must be a different contact to your travelling companion if applicable)*Emergency contact phone number*2. TRAVEL INSURANCETravel insurance is essential for all of our trips. When you booked, you agreed to have travel insurance in place that covers you for all of the activities you plan to undertake on your retreat (including winter activities if applicable) and have adequate cover for travel delay, cancellation and curtailment, medical expenses and your personal belongings. Please provide us with the details of your insurance here. Thank you.Insurance company name*Insurance policy number*3. ABOUT YOUR HEALTHThis section of the form has been designed to identify if any activity might be inappropriate, need adjusting or if you need to take further medical advice. It also gives our team the opportunity to review everyone’s needs in advance and plan accordingly.Do you have or have you had any of the following. Please tick any that apply* Allergies Stroke Cancer Diabetes Long Covid Skin problems Currently pregnant Heart attack/pains in heart or chest Pacemaker Haemophilia Hyper or hypo thyroid condition Epilepsy Back problems Asthma High blood pressure Low blood pressure Bone or joint conditions History of haemorrhage Fainting or dizziness Circulatory disorders or thrombosis NA If you have ticked any of the above, please give us more details if necessary - when you experienced the condition, what treatment you had or are having etc.Are you taking any medication/s?* Yes No Please let us know what medication/s you are taking4. MORE ABOUT YOUWhy did you book this retreat?* To relax and leave any worries behind for a while To have fun and meet new people To be cared for and looked after To feel physically and mentally better To feel like I have reclaimed myself To improve my yoga practice To gain tools and strategies to manage stress Please tick any that applyIf you'd like to tell us more, you can do so hereIs there anything that you are concerned about?*How long you have been practising yoga and what style of yoga?*Have you attended classes with this retreat teacher before?* Yes No 5. YOUR TRAVELAs a Bcorp company we are committed to measuring the carbon footprint of each retreat. We appreciate you taking the time to share your travel details. We offer shared transfers to reduce the number of car journeys wherever possible. We will organise shared transfers to collect you from Palma Mallorca Airport at 14.00 on the 23rd September and take you back to the airport for 12.00 departures on the 28th September. If your travel falls outside of these times we can organise additional transfers. Transfer costs will depend on the number of people in each car.Your arrival flight number*Your arrival date*Your landing time*Your departure flight number*Your departure date*Your departure time*If you have a different travel plan please let us know here6. EXTRA ACTIVITIESWould you like to pre-book the private yacht trip as described in your Welcome Pack?* Yes please No thank you Cost to be confirmed once we know numbers.Would you like to pre-book a massage treatment with Melysa?* Yes please 60 minutes Yes please 90 minutes No thank you Cost to be confirmed once we know numbers.7. MENUYour menu is mostly vegetarian and includes some fish. Please confirm whether you are happy to eat fish during your retreat* Yes please No thank you 8. YOUR CONSENTConsent* I confirm that I have read, understood and answered all the questions to the best of my knowledge.*Consent* I have obtained appropriate medical advice and/or consent for any health condition that has been mentioned above and have disclosed all information relevant to my participation in the retreat activities.*Consent* I have declared and received pre-approval for any food allergy or specialist dietary request.*Consent* I acknowledge that Reclaim Yourself Retreats are not responsible for any harm caused to me for any medical conditions/allergies not declared or where I have not followed appropriate medical advice.*Please click below to submit your form and check that you see a 'confirmation page' otherwise your form may not be submitted properly.
