Darjeeling Retreat

Address

Street Address *

City *

State *

Country *

Postal code *

Emergency Contact Name *

Emergency Contact Number *

If your answer above is others, please specify

Did you have Neck/Back/Spine injury: *

Did you have muscular injury? *

Other medical condition, injury, or disability: *

Any recent surgery: *

Please specify if you have any diet restrictions

Yoga Level: *

I hereby give my consent for Rudrakshaa Yogashala to take photos/videos for promotional purposes. *

Yes

No

I give permission the teacher to provide physical adjustments and touch to correct my posture during the class. *

Yes

No

Waiver and Release: By signing this form, I acknowledge that I am voluntarily participating in yoga classes and understand the associated risks. I kindly release the instructor and the organization from any responsibility or liability for any injury or harm that may arise during my participation.

Retreat Payment *

S$ 1650

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