07545 187 885 | email@example.com
To book your session please use the form below
Please select the retreat you would like to book.
Pilates RetreatYoga Retreat
Your Name (required)
Date of Birth (required)
Contact Number (required)
E-mail Address (required)
How many people are you booking for ? (required)
Please tick the box of the room you would like to book. (required)
Double occupancy twin room £680Single occupancy room £900
Any room requests please state below.
Do you have any allergies?
Do you have any special dietary requirements? Eg: Vegan, Vegetarian, Allergies etc.
Do you have and food/cuisine you dislike or prefer not to have for example seafood, bread etc?
Emergency Contact Number (required)
Doctors Name (required)
Doctors Number (required)
What is your occupation and does it involve repetitive movements or prolonged postures?
Are there any movements or positions that you find uncomfortable?
What are your main aims and reasons for doing Pilates?
Do you do any other form of exercises/sport or training? Please give details below.
Please tick any conditions you have been diagnosed with, had treatment for or any conditions you are suffering from, then give details below.
DiabetesHigh Blood PressureLow Blood PressureSciaticaPregnancy
If yes to any off the above, please add how many weeks and have there been any complications?
Heart ConditionsCarpel Tunnel SyndromeArthritisOsteoporosisLower Back Pain
If yes, please add how many previous episodes you have had.
Any other spinal conditionsPelvic PainProlapsed discsBronchitisStrokeDermatitisEpilepsyCancerAsthmaInjuriesOther
Please give any details below and any other relevant information
Please inform your teacher immediately should any of the conditions above arise or if any of your details change.
I have read and agree to the terms and conditions
Read our Terms and Conditions
Book Online or for more information call us on 07545 187 885 or email firstname.lastname@example.org
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Classes with 1:1 attention allowing us to cater for everyone whatever your needs
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