Yoga Weekend Prices and Booking Form

Sarah’s Yoga - Booking Form

Ilsington Country House Hotel

Name: Address:

DOB: Postcode:

Tel: Mobile:

Email: Emergency Contact Number:

Yoga experience: Dietary preferences or allergies?

Please tick room requirement

Single

occupancy

Sharing Twin/Double

per

person

Non participating rate

if sharing with participating

friend or partner

Standard

Payment - please delete as appropriate

I am enclosing payment of £80.00 deposit (non-refundable)

Balance due by

I am enclosing payment for full cost at ………….

Cheques payable to Sarah's Yoga. Please send completed booking form with payment to Sarah’s Yoga,

Health Information – Please read the following carefully and let me have brief details where appropriate.

If you

Ø have any serious medical condition (e.g. heart disease or circulatory disorders,

back injuries, high/low blood pressure, cancer, epilepsy, diabetes, detached retina, recovery from recent surgery)

Ø have any muscle or joint problems

Ø are currently taking any medication or are receiving any medical treatment

Ø are pregnant

Ø have any other condition not mentioned above that may affect your yoga practice

I agree for my own safety and well being to inform the course leader prior to the yoga weekend

should any changes in the information given on this form occur, or if any medical, physical or

emotional problems should arise during the weekend.

Please sign below to show you have read and understood the above

Signed: Date:

Please note – this information will be treated in the strictest confidence.