WILD HEART TENDER SOUL GROUP IMMERSION APPLICATION FORM Your Name(Required) First Last Email(Required) Your Phone(Required)Number of ParticipantsShare a random fun fact about yourself!(Required)Health Information:Everything you tell me here is confidential, and by answering these questions you confirm your consent that: - All information provided is correct - To inform the instructor about any changes to your health or ability to exercise - Helen Barnett disclaims any liability for injury, damage, or loss resulting from activity undertaken during Yoga sessions Have you practiced yoga before? Yes No Do you have any of the following: Injuries (old or current) Physical limitations Recent surgery Pre-existing medical conditions Physical health concerns Mental health concerns Take any regular prescribed medication If yes to any of the above, please provide details here(Required)Are you pregnant or hoping to be pregnant during the 3-months of the immersion?(Required)Will you have given birth in the past 6 months during the immersion? Yes No Is there anything else you would like me to know before the immersion begins?(Required)Choose Programme Option Early Bird € 777 Early Bird € 266 (3 x monthly instalments) Single Payment Price: Instalment Price: Total Payment(Required) Would you like to be added to our mailing list (we promise not to spam you, and you are free to unsubscribe at any time): Yes, add me please. Δ
