Ayurveda Retreat Application Form
for participation in Living Ayurveda Retreats at Shambala Margaret River. Filling out this form is Step 1) of your booking process. Step 2) is securing your place with a payment.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
Street Address
City
State / Province
Postal / Zip Code
Which retreat are you interested in attending?
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Living Ayurveda Retreat November 17-20th '23
Living Ayurveda Retreat January 19th-22nd 2024
7-day Ayurvedic Healing & Detox Retreat April 2024
What is your intention for attending this retreat?
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What is your experience with Ayurveda and Yoga?
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Do you currently experience any physical ailments or any mental or emotional health concerns or challenges at the moment? Please explain in detail, so we can support you best!
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Do you have any dietary requirements? (Food on Retreat is vegetarian)
*
have you attended a retreat or event with Lena before?
*
Where did you hear about this retreat?
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Select your accommodation option. The standard inclusion is dorm accommodation in the beautiful Meeting House in twin-style shared alcoves divided by sliding walls and curtains. If you snore loudly, please select a private option.
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Shared accommodation in the Meeting House
Camping - BYO tent/camper/setup
Glamping in a private bell tent, bedding provided
I commit to abstain from drugs and alcohol for the entire course of the retreat.
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Yes
No
I know that I myself am responsible for my own healing and empowerment and my own willingness and active participation is required to facilitate positive change in my state and body.
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Yes
No
Would you like to be added to our email newsletter?
*
Yes
No
Is there anything else you'd like to share with us?
Disclaimer
I declare that all the information I have disclosed is correct. I declare that I will exercise all precautions advised by instructors during the yoga course, not go beyond my own physical limits during yoga practice. I will not hold the instructors or Shambala Margaret River or Earth Medicine Co legally responsible for any liabilities or damages should I be injured before, after and during this retreat. My participation in all activities is confirmation that I am fully responsible for any and all risks, injuries or damages known or unknown without limitation. I acknowledge that it is my personal responsibility to inform my instructor about any physical complications or limitations ahead of the event or at the start of the appointment and agree that all instructions are merely an invitation and I hold full responsibility to listen to my own body and its need first and foremostly.
I understand and agree to the declaration above:
*
Yes
Signature
*
Submit
Should be Empty: