"*" indicates required fields RETREAT GUEST INFORMATION FORMThank you for taking the time to complete this form. It’s a key part of our preparation, giving us all the details we need — from travel and transfers to your personal preferences — so we can look after you and make your retreat seamless, safe, and enjoyable. Reclaim Your Self 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 Preferred name (if different)PronounsNationality*Date of Birth* Day Month Year Email* Mobile number with dialling code*Emergency contact name*Emergency contact phone number*2. Your travelAs a B Corp company, we are committed to keeping our carbon footprint as low as possible in the countries we visit. To help us do this, we organise shared group transfers rather than individual journeys. Please share your travel details so we can check your flights match our complimentary transfers. Thank you.I am travelling on a LATAM flight which arrives on Baltra Island at 11:07 on 29.11.25* Yes No I am travelling on a LATAM flight which departs Balta Island at 11:47 on 06.12.25* Yes No If you have different travel plans please include them here. Thank you.3. 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 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*4. 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 taking5. 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 7. 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.*
