Retreat Booking Form & PARQ

Retreat Booking form and PARQ
Please complete and submit this booking form and physical activity readiness questionnaire (PARQ).
Full payment or deposit of £150 for early bookings will secure your space. If paying a deposit, the full balance is due 10 weeks before the retreat. Bank details for payment will be sent by email when we receive your booking and will need to be made by bank transfer.

* Indicates required field

Email *

Name *

First

Last

Phone Number *

Emergency contact name and number *

Retreat dates you wish to book. Include single or shared occupancy request. *

Where did you hear about Absolute Yoga and Pilates? *

Why have you chosen this retreat and what do you want to get out of it? *

Agreement (Terms and conditions):

We will make every effort to accommodate your booking, however accommodation is subject to availability.
By submitting this booking form, you agree to the dates selected and understand that payment cannot be refunded if you are unable to attend.
Full payment for the retreat is required in advance (for early bookings, a deposit payment will secure a space).
You need to complete the Physical Activity Readiness Questionnaire (PARQ) below.
By submitting this booking form, you have the option to receive emails and communications from us. This will keep you informed on current services available. You can unsubscribe at any time. This is following General Data Protection Regulations (GDPR) 25th May 2018.

Health Screening:
Please answer each question with a yes or no. (All information will be treated confidentially)

Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor? *

Do you ever feel pain in your chest when you do physical activity? *

In the last month, have you had chest pain when you are not doing physical activity? *

Do you lose your balance because of dizziness or do you ever lose consciousness? *

Do you have a bone or joint problem, for example, back, knee or hip? If you answer yes you are advised to seek advice from a health care professional first. See declaration below *

Is your doctor currently prescribing drugs for blood pressure or a heart condition? If you answer yes you are advised to seek advice from a health care professional first. See declaration below. *

Is your doctor currently prescribing drugs for blood pressure or a heart condition? If you answer yes you are advised to seek advice from a health care professional first. See declaration below *

Is there any other reason why you should not participate in physical activity? *

IF YOU HAVE ANSWERED YES TO ONE OR MORE QUESTIONS
You should talk to your doctor by phone or in person before you start becoming more physically active. Tell your doctor about the questionnaire and which questions you answered YES to. Please also tell your instructor. If you have already got medical clearance for Yoga/Pilates or moderate exercise in general, please fill in the declaration below.

You may be able to do any activity you want – as long as you build up slowly and gradually. Or you may need to restrict your activities to those that are safe for you. Talk with your doctor about the kinds of activity you wish to participate in and follow his/her advice. Yoga/Pilates exercises are generally safe for most people, it improves flexibility and strengthens your deep postural muscles – particularly your deep abdominals and back muscles – as well as improving your overall posture and body awareness, thus minimising the chance of future injuries.

IF THE ANSWER IS NO TO ALL QUESTIONS you can reasonably be sure that you can start to become more physically active and take part in a suitable exercise programme. Begin slowly and build up gradually!

PLEASE NOTE

If your health changes subsequently so that you answer YES to any of the above questions, please inform your teacher.
If your doctor has recommended that you avoid any movements, make sure that you let your teacher know.

By submitting this booking form you confirm you have read and understand this questionnaire. If you have any concerns, contact us by email and ensure you speak with your teacher at the start of your class.

Signed Agreement and Declaration (Declaration applies if you have answered yes to any of the above questions) I agree to the terms and conditions above. I declare I have been cleared by my doctor (GP, specialist or other qualified health professional) to take part in moderate exercise. Please input your full name to indicate your informed consent. *

Mailing list *

I agree to receiving marketing and promotional materials

Submit

Absolute Yoga and Pilates;
'Friendly classes that help you enjoy a healthy and balanced life'

t: Pauline 07821 969405
e: pauline@absoluteyogaandpilates.co.uk

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