Yoga Retreat Health Declaration Form
Full Name
Date of Birth
Email Address
Phone Number
Emergency Contact Name & Number
Please indicate if you have or have had any of the following:
Heart conditions
High/Low blood pressure
Respiratory issues
Recent injuries
Pregnancy
Other (please specify below)
If any, please provide details:
Please list any allergies (including food or medication):
Are you currently taking any medications? If yes, please list:
Is there any reason you should not participate in physical activities?
Declaration: I confirm that the above information is correct and complete to the best of my knowledge. I agree to inform the organizers if there are any changes. I understand that participation in the yoga retreat is at my own risk.
Date