Name *
Name
Address
Address
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 *Early Bird Rate require payment or £100 deposit to be received by 07/12/17. Full rate applies 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. After submitting this form 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). Payment options will also be given. Early bird discount continues until 31st November 2017. Spaces are confirmed on receipt of a £100 deposit. Full payment must be received by January 11th 2018. Please contact Hayley@LatitudeWellbeing.com with any queries. Thank you - Looking forward to seeing you on retreat!