"*" 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. PASSPORT INFORMATIONPlease enter your details exactly as they appear in your passport. Any discrepancies may cause issues with the travel arrangements we book on your behalf as part of your retreat. Please note that any costs incurred as a result of incorrect information being provided may be your responsibility. We collect your passport information solely for the purpose of arranging travel associated with your retreat. Your information will be stored securely, shared only with relevant travel providers where necessary, and deleted when it is no longer required.Your name (exactly as shown on passport)* Given names Surname Passport number*Date of Birth* Day Month Year Nationality*Place of birth*Country of issue*2. ABOUT YOUEmail* Mobile number* Country Phone Number Emergency contact first and last name*Your emergency contact must NOT be someone attending the retreat.Emergency contact phone number Country Phone Number 3. Your domestic flight detailsOn 9th November, the transfer from FTE airport to the accommodation takes approximately 4 hours, so unfortunately there is no option to make your own way to the accommodation. On the 16th November: If you are not travelling on the recommended domestic flight we can arrange a taxi for you from our final accommodation. Please note that we will not know the cost of this taxi in advance.Please confirm which recommended domestic flight you have booked on the 9th November:* I have booked flight AR 1840: Buenos Aires (EZE) 06:10 → El Calafate (FTE) 09:30 I have booked flight AR 1848: Buenos Aires (AEP) 05:10 → El Calafate (FTE) 08:30 I have other plans Please confirm you have booked the recommended domestic flight on the 16th November: I have booked flight AR1895 : El Calafate (FTE) 16:30 → Buenos Aires (AEP) 19:30 I have other plans Please share your flight times and flight number herePlease share your flight times and flight number 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 activities*Please let us know if you would like to join either of the additional experiences taking place on 12th November (details can be found on page 17 of your Welcome Pack). As both experiences run at the same time, it is only possible to take part in one of the activities. We will be in touch before the retreat to arrange payment. (Minimum numbers apply) Horse riding $120 per person Mountain biking $120 per person Neither, thank you 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 confirm that, if I choose to take part in horse riding or mountain biking during my retreat in Patagonia, I will ensure that my travel insurance covers these activities. If they are not already included in my policy, I will arrange additional cover before participating.*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.*
