Registration – Yoga & Climbing registration form Nomia`s Yoga & Climbing Retreat Please enable JavaScript in your browser to complete this form.Name *FirstLastDate of birth *Do you practice yoga regularly? *You can specify how often you doDo you climb regularly? *You can specify how often you get to climbWhere do you get to climb?Climbing GYMOutdoorsOtherPlease share what you would like to receive from your vacation? *Do you have any requests regarding your vacation?Menu preferences: *VeganVegetarianOmnivoreOtherPlease indicate if you are allergic or have a sensitivity to a certain food *Allergic to beesAllergic to nutsSensitive to glutenSensitive to lactoseOtherNo allergiesPlease tick all that apply and give further info below where relevantHave you suffered or do you suffer from any of the following? *High Blood PressureLow Blood PressureCardiac ProblemsAsthmaSkin DisordersArthritisPhlebitisVaricose VeinsEpilepsyOtherNone of the abovePlease tick all that apply and give further info below where relevantPlease give more information on any relevant health conditionsHave you experienced any kind of surgery in the last 3 years? *If you didn't, note 'No'. If you did, please give more infoHistory of injuries or illnessesPlease list anything else you feel may be relevantWhich accommodation are you booking? *Room for one - Double bed - 1900€ (per person)Suite for two - Double bed - 1700€ (per person)Double room - Double or twin bed - 1650€ (per person)Accommodation is limited, and we operate on a first-come, first-served basis. If you register with a friend, let us know, and we'll ensure you're placed togetherPlease tick the boxes below to confirm you have read this information and that you consent to what is described *I take full responsibility for my own health and well-being during Nomia`s Yoga and Climbing retreat.I confirm that all the information given is true and correct. Nomia Experience will not be held responsible for any undisclosed information later be proved to have affected any services given.I understand that I am responsible for having adequate travel insurance, and that Nomia Experience will not be held responsible for any damage or injury sustained during activities that take place outside of the retreat.I agree that Nomia will use the photos I appear in, as long as they do not contain offensive or Inappropriate content.I confirm that I have read the Privacy Policy visible on the website, and Booking Terms & Conditions and agree to the practices described therein.I understand that the online submission of this form replaces my signature and I consent to my health questionnaire being stored digitally on a password protected device.Submit Instagram Facebook Whatsapp Youtube
