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Retreat Registration Form

Retreat

Member Number

First Name*

Last Name*

Gender*

Male

Female

Date of Birth*

Email*

Mobile Number*

Home / Office Phone Number

Please write the name of the person who can be contacted immediately in an emergency situation*

Relationship*

Phone Number*

Status*

Single

Married

Others

Nationality*

ID/Passport Number/Student Card*

Country*

State/Province

City*

Home Address*

Postcode/Zip*

Have you ever taken a yoga class before?*

Yes

No

If yes, where?

Type of Yoga you are practicing

Years of practicing Yoga

Are you currently teaching or had taught Yoga?*

Yes

No

If yes, please state type of Yoga

Number of years you have taught yoga

Frequency of your teaching

Do you hold any Yoga teaching qualification?*

Yes

No

If yes, please state type of certification

Year of Certification

How often do you practice yoga?

Where do you practice?

Do you have any current or past injury?*

Yes

No

If yes, please state

Do you have or have had any medical problems or serious operations in the past?*

Yes

No

If yes, please state

Are you pregnant?*

Yes

No

What is your purpose of joining our Retreat?*

What do you expect to gain from this Retreat?*

Do you have any food allergies?*

Yes

No

If yes, please state

Do you have any food restriction (vegetarian and others)?*

Yes

No

If yes, please state

Hobby*

Music

Reading

Sports

Travel

Culinary

Other

Where did you get information about us?*

Facebook

Youtube

Twitter

Instagram

Website

From friends

Other

Are you willing to accept all forms of promos, newsletters from Riana Yoga?*

Yes

No

Upload Photo*

Liability Waiver Agreement By registering in this retreat, I will assume full responsibility for my own well-being during the duration of the retreat. I understand that Yoga involves physical movements and as in any physical activity, the risk of injury is always present. I assume full responsibility of any risk or damage, known or unknown, which I might incur as a result of my participation in this retreat. I affirm that I alone am responsible to decide whether to practice yoga. I hereby agree to irrevocably release and waive any claims that I have now or hereafter may have against Riana Yoga Institute and the instructors/teachers of this retreat. I agree that there is no refunds, cancellations, credits or transfers prior to, during or after the retreat.

Terms and conditions*

I agree

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