Full Booking FormStep 1 of 4 - Contact Details0%Contact DetailsFull Name*Full Postal Address*Mobile Phone Number*Home Phone Number*Email* Date of Birth*Weight*Height*Dress Size*Sex - Female or Male*Descirbe your activity level.*Retreat date you have booked or interested in*Medical QuestionnaireAre you currently taking any prescribed medication?* Yes NoAre you registered as a disabled person?* Yes NoDo you have any allergies?* Yes NoAre you a smoker or do you Vape?* Yes NoAre you currently suffering or have you ever suffered from heart trouble* Yes NoAre you currently suffering or have you ever suffered from lung disease* Yes NoAre you currently suffering or have you ever suffered from stomach / bowel trouble* Yes NoAre you currently suffering or have you ever suffered from diabetes / hypoglycaemia* Yes NoAre you currently suffering or have you ever suffered from jaundice / hepatitis* Yes NoAre you currently suffering or have you ever suffered from joint problems* Yes NoAre you currently suffering or have you ever suffered from asthma* Yes NoAre you currently suffering or have you ever suffered from sight / hearing problems* Yes NoAre you currently suffering or have you ever suffered from headaches / migraines* Yes NoAre you currently suffering or have you ever suffered from kidney / bladder disorder* Yes NoAre you currently suffering or have you ever suffered from back / neck problems* Yes NoAre you currently suffering or have you ever suffered from high blood pressure* Yes NoAre you currently suffering or have you ever suffered from depression / anxiety* Yes NoAre you currently suffering or have you ever suffered from hernia / rupture* Yes NoAre you currently suffering or have you ever suffered from epilepsy* Yes NoAre you currently suffering or have you ever suffered from surgical operations* Yes NoAre you currently suffering or have you in the past suffered with any type of eating disorder* Yes NoIf you answered yes to any of the above questions please provide details belowNutritional QuestionnaireAre you a Vegetarian?* Yes NoDo you eat fish?* Yes NoAre you vegan?* Yes NoAre you Celiac?* Yes NoAre you gluten intolerant?* Yes NoAre you wheat intolerant?* Yes NoAre you lactose intolerant? Yes NoAre you allergic to seeds?* Yes NoDo you have a nut allergy?* Yes NoDo you have any food intolerance or allergies not mentioned?* Yes NoPlease provide any further details on any positive answers to any question above or any dislikes that may help us to best meet your dietary requirements*PAR-Q & YouFor most people, physical activity should not pose any problems or hazard. PAR-Q has been designed to identify the small number of adults for whom physical activity might be inappropriate or those who should seek medical advice before increasing their physical activity level. Common sense is your best guide in answering the following questions. Please read them carefully and answer honestly by selecting either 'Yes' or 'No'.Has your doctor ever said you have heart trouble?* Yes NoDo you frequently have pains in your heart and chest?* Yes NoDo you often feel faint or have spells of severe dizziness?* Yes NoHas your doctor ever told you your blood pressure was too high?* Yes NoAre you currently taking any prescribed medication?* Yes NoHas your doctor ever told you that you have a bone or joint problem that may be aggravated my exercise?* Yes NoAre you pregnant?* Yes NoAre you over the age of 65 and not accustomed to vigorous exercise?* Yes NoIs there any other good physical reason not mentioned here why you should not follow and activity programme if you wanted to?* Yes NoIf you answered Yes to any of the above questions please provide further detail including dates where relevant.You should also talk with your doctor BEFORE you commit to this programme.EmailThis field is for validation purposes and should be left unchanged.