Name *
Date of birth *
Date of birth
What would you most like to get out of this weekend? *
Accommodation preference *
Please state in the comments section below if you would like to share a room with a specific guest(s)* *Shared rooms are most commonly twin rooms, up to three sharing can be accommodated as required whilst availability lasts *To benefit from our Early Bird Rate a deposit of £100 must be received by 11/11/19. The standard rate will apply after this date.
We are very happy to cater for dietary requirements with prior notice. Please state below:
Health questionnaire *
Please indicate if you are currently experiencing any of the following:
Please indicate if you have been diagnosed with or received treatment for: *
How did you hear about this weekend? *
Please tick here if you DO NOT wish to be contacted by Latitude Wellbeing regarding future promotions, events or information.
Declaration *
Declaration: By signing this document, I demonstrate understanding that all physical activity involves a degree of risk. I declare that I am in good health to participate in this activity and know of no reason not to. If at any time I am unsure of the exercise or am experiencing discomfort or pain, I will stop and inform the instructor immediately. I am responsible for and aware of my limitations to stop any activity before I become unwell or injured and I will inform Latitude Wellbeing immediately of any change in my health status. I understand that Pilates and yoga may involve hands-on adjustment and I hereby give consent for this. If I have consulted a physician, I am following their advice. I understand and agree that this activity is undertaken at my own risk and I therefore waive any right for myself or any of my affiliates to seek to bring any form of legal action against Latitude Wellbeing or any representative thereof at any point. Photography may be present at Latitude Wellbeing events for use in promotional material. If you would prefer not to be included in any images please inform the teacher directly and your image will not be used. On submitting this form and after receipt of the £100 holding deposit you will be contacted with additional information regarding the weekend, travel and response to any questions or comments you may have (please note this is an individual response instead of an automated email, therefore please don't be concerned if it does not arrive immediately). Spaces are only confirmed on receipt of a non-refundable deposit of £100. Early bird discount continues until 11th November 2019, in order to benefit from this discount your deposit must be received before this date. Full payment for all bookings must be received by January 3rd 2020. Please contact with any queries. Thank you - Looking forward to seeing you on retreat!