Pre-retreat Questionnaire
ReWire & ReWild with Jim Harrington - Mucklagh Lodge, Wicklow
Customer Details:
Full Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
E-mail
example@example.com
What styles of yoga or movement are you familiar with or do you enjoy most?
*
Do you have any current or past injuries we should be aware of?
*
Are there any movements or postures that you know don’t feel good for your body? Are you happy to receive hands-on adjustments from me during the practice?
*
Do you have any health conditions (physical or mental) we should be aware of to support your comfort and safety?
*
Are you currently taking any medications that it would be helpful for us to know about?
*
Do you experience anxiety, fatigue, or other symptoms that might affect your retreat experience?
*
Do you have any dietary requirements, allergies, or intolerances? (Please be specific – e.g. vegan, gluten-free, nut allergy)
*
Do you have any strong dislikes or preferences when it comes to food?
*
What drew you to this retreat?
*
During the retreat we may be capturing moments to share the magic of ReWire & ReWild. Please let us know your preference:
*
I consent to being photographed or filmed during the retreat. I understand these images may be used for future retreat marketing.
I do not consent to being photographed or filmed. I understand my privacy will be fully respected.
Submit
Should be Empty: