Tinnakilly 2022 - 5 Day Residential Retreat Registration Form

Registration Form

Fasting, Nature Walks & Mindfulness - 5 day residential Retreat in Tinnakilly Lodge
Due to the current environment, our fasting programs are reserved for people with no Coronavirus related symptoms and who have not been in contact with an infected person close to the time of the retreat. You will be required to confirm this 24 to 48 hours prior to arriving at the retreat.

Please note: The purpose of the "Health Questionnaire" part of this online registration is strictly for us to ascertain whether or not you are fit to fast and to ensure you do not have health issues that would fall in the "contra-indications" conditions as per our website page "Who should not fast" here.

This form will be kept strictly confidential, reviewed by Gabby, a nurse of over 30 years, and destroyed (online and offline) at the end of the retreat.
Personal Information

Please fill in as accurately as possible
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

EirCode
Phone Number*

Area CodePhone Number
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Name and number of person to contact in the event of an emergency:*
Your occupation
Stress Level at Home*

Not very stressedModerately stressedHighly stressed
Stress Level at Work*

Not very stressedModerately stressedHighly stressed
Activity Level (Physical activity is anything that makes you breathe faster and feel warmer. It could be a brisk walk, running, cycling, swimming, dancing, an active job, tennis, football, etc.)*

Inactive (Less than 30 minutes a day)Moderately active (Between 30 and 60 minutes a day)Active (Between 60 and 150 minutes a day)
Is this your first Fast?*

YesNo
If the answer is no, please elaborate
Where did you fast before, in a group, at home, what type of fast, intermittent or other, etc.
How did you hear about us?*
Choose your accommodation*

Single occupancy (€900 pp)Twin share (€750 pp sharing)
If sharing a twin/double please let us know with whom.*
Confidential Health Questionnaire

Please answer truthfully and as accurately as possible.
Should you have a specific ongoing health issue, we need to be aware of it. It is therefore important (and your responsibility) that you let us know if you are under medical treatment for one or more pathologies. If this is the case, please give details in the box below.
My health issues and treatments are as follows:*
if not applicable, please type N/A in the box
Weight
in kilos
Height
in cms
Medical Disclaimer - Our retreats are for people of good general health as stipulated on the contraindications page of our website.*

I certify that I am in good general health with no medical treatment.I agree that it is my full responsibility to check with my doctor that my state of health is compatible with my Detox plans.I confirm I have read the contraindications of Detox through fasting available on http://www.thefastwaytodetox.ie/who-should-not-fast, and accept them knowingly.I undertake to inform The Fast Way to Detox of any change of situation concerning my health that may occur between today and the start of the retreat.
This detox is based on the concept of "Fasting & Hiking" which involves spending time on nature walks for movement, mindfulness and oxygenation. We endeavour to chose the walks with consideration and according to the fitness of the majority if we can't accommodate everyone.*

I am able to walk about 3 to 5 kilometers a dayI am unable to walk about 5 to 7 kilometers a day
General information and disclaimers
General Disclaimer*

I have been informed that the driving of a motorised vehicle is strongly discouraged during the whole duration of the retreat if I am on the Buchinger Liquid Type Fast.Therefore, I accept to ride to and from the hikes/nature walks in the privately owned vehicle of the retreat organisers.Should anything happen to my person during the hikes/nature walks or the transport, I will not hold the retreat organisers responsible.The detox runs over five days, starting from Sunday evening at 6 pm (arrival from 4.30 pm), until Friday around 1pm after lunch.I hereby declare that the information provided on this form is true, complete and correct.
What is included in the price?

During your detox, you will be able to enjoy a range of services and/or activities as follows (these may vary slightly):
- The “step by step” preparation guide lines for the pre & post detox,
- 5 nights in spacious accommodation/all bedrooms with en-suite,
- Daily guided hikes/nature walks,
- Guided meditations or relaxation sessions,
- A complimentary 60 minutes treatment (massage, reflexology, etc.)
- Daily gentle physical workshop - Yoga, Body Stretch & Joint Loosening, or Do-in (a Japanese self-massage technique derived from Shiatsu and based on the theoretical principles of Traditional Chinese Medicine)
- Evening workshops on topics such as fasting, nutrition, mindfulness, what is meant by healthy lifestyle, etc.
- Freshly made organic detoxing juices,
- Freshly made organic detoxing vegetable broth,
- A variety of organic detoxing herbal teas available throughout the day,
- A delicious "re-feeding meal" served on the last day with recipes to take home,
- Guaranteed full devoted attention, coaching and support from Gabby and myself.
What is NOT included in the price?

Should you want to avail of optional testing, cutting edge treatments and bioenergy medicine protocols, Gabby, our nurse of 30+ experience, will be
delighted to offer the following (these may vary slightly):
- Micro current therapy
- Scalar wave treatment
- Infra red sauna
- Enemas and coffee enemas
- PEMF treatments
- Phlebotomy services for general health screening or more specific health conditions
- Stool testing for gut and microbiota health
- Food intolerance test
Should you want to avail of extra pampering, Michelle, our Holistic Massage Therapist will be delighted to offer the following (these may vary slightly):
- Full body massage
- Neck, back and shoulder massage
- Back massage and scrub
- Head massage
- Facial
- Reflexology
- etc.
Further more ...

Everything we propose is without obligation. This is YOUR week to recharge rest and be in the moment. However, we will encourage you to take part as much as possible in order for you to get the most out of your detox retreat. You can be assured of our full professional coaching, support, and our complete devoted attention throughout your stay.
Terms and Conditions:*

I agree to pay the deposit of €250, on receipt of my enrolment confirmation, and the balance 1 week prior to the retreat.I understand that should I cancel within 15 days prior to the retreat 50% of my deposit will be lost (i.e. €125)I understand that for cancellations less than 1 week before the start of the retreat, the cost of the entire retreat will be due, unless my place can be filled.I understand that in the event of an early departure from the retreat, no matter what the cause is, the cost of the entire retreat will be due.
In the event that we don't meet required numbers on any of our scheduled retreats, we reserve the right to cancel. In this case, your deposit can be moved to a future retreat date (if it is suitable to you) or we will issue a full deposit refund.
A confirmation email and an invoice will be sent to you once your registration form is accepted. A deposit of €250 will then be required to secure your place.*

Read & understood
Payment Options

Bank transferRevolut
This form, or email and any files or documents transmitted with it are confidential and intended solely for the use of the individual(s) or entity named above. If you have received this email in error you must not use, copy, distribute, disseminate or disclose the information contained in it. Please notify us immediately, delete the email from your computer system, and destroy any hard copies you may have created. The recipient should check this email and any attachments for the presence of viruses. The Fast Way to Detox is registered in the Republic of Ireland (Registration No: 639962) Registered Office: 23 Brighton Wood, Brighton Road, Foxrock D18 F44E, Ireland
Signature*

Clear
Please sign to confirm you have read the entirety of this form and have answered truthfully.
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Registration Form

Personal Information

Confidential Health Questionnaire

General information and disclaimers