Bliss Out Retreat Atteendee Form – Ananda Wellness Yoga

Bliss Out Yoga & Wellness Retreat

Are you ready for fresh mountain air and a time to recharge? This retreat isn’t called Bliss Out for nothing! Please fill in the personal information below. If you booked for another retreater, please also fill in their information. If you booked for more than two people, I will contact you to get the remaining guests’ names.

Retreater one

Retreater 1: Bliss Package Selection

Retreater 1: Room/ Cabin booked * please select an option

Retreater 1: Name & Surname

Retreater 1: Birthdate

Retreater 1: Email

Retreater 1: Contact Number

Retreater 1: Any Dietary Requirements

Retreater 1: Please specify and explain any injuries or physical conditions you may have and include if you are receiving treatment from your Medical Practitioner:

Retreater 1: Are you pregnant?

Yes No

Retreater 1: If you are pregnant, please indicate how many months

Retreater 1: Any other requests or comments

Retreater 2: Bliss Package Selection

Retreater 2: Room/ Cabin booked * please select an option

Retreater 2: Name & Surname

Retreater 2: Birthdate

Retreater 2: Email

Retreater 2: Contact Number

Retreater 2: Any Dietary Requirements

Retreater 2: Please specify and explain any injuries or physical conditions you may have and include if you are receiving treatment from your Medical Practitioner:

Retreater 2: Are you pregnant?

Yes No

Retreater 2: If you are pregnant, please indicate how many months

Retreater 2: Any other requests or comments

Bliss Out Yoga & Wellness Retreat

Retreater one

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