"*" indicates required fields RETREAT GUEST INFORMATION FORMPlease complete this form so we can plan in advance to meet your needs. We’d like to know why you’ve booked with us so we can create a great retreat experience for you. We also need to be sure there are no medical conditions that will prevent you from enjoying your time with us. Reclaim Your Self is registered as a Data Controller with the ICO. Your personal data is treated in complete confidence and is protected according to the Data Protection Act/GDPR.1. ABOUT YOUName as in passport* First Last Nationality*Date of Birth* Day Month Year Email* Mobile number with dialling code*Emergency contact name*Emergency contact phone number*2. Your travelAs a Bcorp company we are committed to measuring the entire carbon footprint of each retreat. To help us to do this we need to know your travel details. We appreciate you taking the time to share these. We also need to check your travel matches our transfer options. Thank you.Your arrival flightArrival date*Flight number*Your landing time*Your departure flightDeparture date*Flight number*Your departure time*Please confirm your OUTBOUND ferry plans on 12th September* I will get the ferry departing Rafina Port 7.50, arriving Andros Island at 9.45 I will get the ferry departing Rafina Port 16.00, arriving Andros Island 18.00 I have other plans Once you arrive at Andros port, there is a 75-minute transfer to the retreat, we will organise a group transfers to match both of the ferry times listed above on 12th September and the ferry time below on the 19th at the end of the retreat. If you choose to arrive or depart at different times, you will need to arrange your own transport, which is approximately €120 one way.Please confirm your RETURN ferry plans on 19th September* I will get the ferry departing Andros Island 14.45, arriving Rafina Port 16.40 I have other plans Please share your plans here4. INSURANCETravel insurance is essential for all of our trips. When you booked, you agreed to have travel insurance in place that covers you for all of the activities you plan to undertake on your retreat and have adequate cover for travel delay, cancellation and curtailment, medical expenses and your personal belongings. Please provide us with the details of your insurance here. Thank you.Insurance company name*Insurance policy number*5. ABOUT YOUR HEALTHThis section of the form has been designed to identify if any activity might be inappropriate, need adjusting or if you need to take further medical advice. It also gives our team the opportunity to review everyone’s needs in advance and plan accordingly.Do you have or have you had any of the following. Please tick any that apply* Allergies Stroke Cancer Diabetes Long Covid Skin problems Currently pregnant Heart attack/pains in heart or chest Pacemaker Haemophilia Hyper or hypo thyroid condition Epilepsy Back problems Asthma High blood pressure Low blood pressure Bone or joint conditions History of haemorrhage Fainting or dizziness Circulatory disorders or thrombosis None If you have ticked any of the above, please give us more details if necessary - when you experienced the condition, what treatment you had or are having etc.Are you taking any medications/?* Yes No Please let us know what medication/s you are taking6. MORE ABOUT YOUWhy did you book this retreat?* To relax and leave any worries behind for a while To have fun and meet new people To be cared for and looked after To feel physically and mentally better To reclaim myself! To improve my yoga practice To gain tools and strategies to manage stress Please tick any that applyIf you'd like to tell us more, you can do so hereIs there anything that you are concerned about?*How long you have been practising yoga and what style of yoga?*Have you attended classes with this retreat teacher before?* Yes No Additional activitiesAs the boat trips require minimum numbers, we’d like to get an idea of whether you would be interested in joining either or both trips (details can be found on page 15 of your Welcome Pack)? Payment for both trips will be made in cash during the retreat. I'd be interested in the visit to Chora town (€300 for 8 people) I'd be interested in the snorkeling boat trip (€300 per boat for up to 8 people) MassagesIf you'd like to pre-book a massage let us know below (details can be found on page 16 of your Welcome Pack). Payment will be collected during the retreat. I'd like a 60 minute session for €85 I'd like a 90 minute session for €125 7. YOUR CONSENTConsent* I confirm that I have read, understood and answered all the questions to the best of my knowledge.*Consent* I have obtained appropriate medical advice and/or consent for any health condition that has been mentioned above and have disclosed all information relevant to my participation in the retreat activities.*Consent* I have declared and received pre-approval for any food allergy or specialist dietary request*Consent* I acknowledge that Reclaim Yourself Retreats are not responsible for any harm caused to me for any medical conditions/allergies not declared or where I have not followed appropriate medical advice.*
