"*" 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 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 Nationality*Date of Birth* Day Month Year Email* Mobile number with dialling code*Emergency contact name*Emergency contact phone number*2. Your travelAs a Bcorp company we are committed to measuring the carbon footprint of each retreat. To help us to do this we need to know your travel details. We appreciate you taking the time to share these. We also need to check your travel matches our transfer options. Thank you.Please let us know your international flight details to Keflavik OR Akureyri airport:Arrival date*Flight number*Your landing time*Departure date*Flight number*Departure time*Would you like us to book you a taxi transfer between Keflavik international airport and Reykjavik domestic airport (journey time is 1 hour)** Yes please No thank you *Final price for this transfer depends on the no. of people. Please confirm you have booked these domestic flights:* 12th October: Icelandair - departing Reykjavik domestic (RKV) 12.05, arriving Akureyri (AEY) 12.50 17th October: Icelandair Flight - departing Akureyri (AEY) 12.20, arriving Reykjavik domestic (RKV) 13.05 Other plans *Your return transfers from Akureyri (AEY) to our venue are included.If you have a different travel plan please let us know here3. 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 6. ADDITIONAL ACTIVITIESWould you like to pre-book a hike on your retreat?** 2hr Valley Hike 80,000 ISK (min 6 people) 5hr Mountain Hike 120,000 ISK (min 6 people) No thank you * Please only pick one hike, if any. Hikes are on the same day.Would you like to pre-book whale watching boating experience? (11,500 ISK P.P/ 3hrs)* Yes please No thank you Would you like to pre-book a massage with Elodie?* Yes please 30 minutes Yes please 45 minutes Yes please 60 minutes No thank you 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.*
