The Conscious Connection Retreat Booking Form

Name*

First NameLast Name

Date of Birth

Date

Email*

example@example.com

Phone Number*

Country Code Phone Number

Address

Street Address

Street Address Line 2

CityState

Post/Zip CodeCountry

Emergency Contact Info

First NameLast Name

Phone Number

Country CodePhone Number

Do you have any health limitations or physical injuries?

Enter none if you have no medical issues

Do you have any allergies or dietary requirements

Have you practiced Yoga before?

If YES, what type of yoga have you practiced?

Comments or Special Needs

Payment options for The Conscious Connection Retreat*

Pay in fullDeposit payment to secure my place

Sign me up! Payment options...*

Essentials Experience - Double Occupancy£995.00

The ‘Essentials Experience’ includes all the immersive group activities at the retreat plus double occupancy in a luxury double or twin room with shared bathroom.

Quantity

Essentials Experience - Single Occupancy£1,295.00

The ‘Essentials Experience’ includes all the immersive group activities at the retreat plus single occupancy in a luxury double room with separate bathroom.

Quantity

VIP Experience - Single Occupancy Ensuite Room£1,650.00

The 'VIP Experience' includes all activities plus 121 transformational coaching / healing sessions and support pre and post retreat with a choice of luxury double en suite room.

Quantity

Total £0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please see the T's and C's in the link below for more info.

AGREEMENT OF RELEASE AND WAIVER OF LIABILITY

I acknowledge that I am voluntarily participating in the Conscious Connection Retreat organised by The Conscious Coaching Group Ltd.

I understand that participation in the retreat may involve certain risks, including but not limited to physical injury, illness, or property loss or damage.

I acknowledge that it is my responsibility to consult with a healthcare professional before participating in any physical activities if I have any health concerns.

I further agree to indemnify and hold harmless The Conscious Coaching Group Ltd, its directors, officers, employees, agents, and representatives from all claims, damages, costs, or expenses, including legal fees, arising from, or related to my participation in the retreat except for death or personal injury due to their negligence and to the fullest extent permitted by law.

I understand that the offerings of this retreat are not a substitute for medical attention, examination, diagnosis, or treatment.

By attending the retreat, I permit The Conscious Coaching Group Ltd to use photos, videos, and other media of me taken during the retreat for promotional or commercial purposes. I understand and agree that the media may be edited, and I have no ownership rights in them. If I do not want my media used for promotional or marketing purposes, I will inform The Conscious Coaching Group Ltd in writing before the retreat. I understand that I will not receive compensation for the use of my media.

I have read the above release and waiver of liability and fully understand its contents. I have had the opportunity to ask questions and seek legal advice if needed. I voluntarily agree to the terms and conditions as detailed in the booking form. This waiver will form part of the terms on signature and governed by the laws of England and Wales.

Confirmation

By acknowledging and signing below, I understand that I am delivering an electronic signature that has the same effect as an original manual paper signature.

Please review our privay policy here

Signature*