Retreat Scotland Health Wellness. Yoga, Juice, Fitness & Fun

Name:

Email:

Phone:

Date Of Birth

Your Height

Your Weight

New Guest or Returning Guest

Retreat Start Day

Gender

Occupation

Emergency Contact

Do you have any health problems past or present

Yes

No

Do you have any current or previous issues with your weight?*

Yes

No

Do you have or had an eating disorder

Yes

No

Any aches or pains

Yes

No

Any muscle or bone problems

Yes

No

Any previous fractures?

Yes

No

Do you have from osteoarthritis?

Yes

No

Any Heart Problems

Yes

No

Have you had or have high or low blood pressue.

Any respiratory problems?

Yes

No

Do you have type 1 or 2 diabetes?

Yes

No

Do you have any allergies we should be aware of? Including fragrance/essential oils allergies*

Yes

No

Are you pregnant

Yes

No

List any medications or supplements you take.

On a scale 1 to 10 with 10 being the highest. Rate your fitness level.

Any information that you wish to share that would/could add to your enjoyment

Any allergies, diet needs.

If choosing any low calorie or detox method, I fully agree that I could be in a calorie deficit and agree to this. I am aware that any extra food or drinks I can purchase locally if required.

I agree

I understand that Retreat Scotland and their staff are fully independent with their programme. They run in different locations as Retreat Scotland are no responsible for third party accommodation or food providers

I agree and understand

By affirming YES to any health-related inquiries, I declare myself physically capable or have obtained clearance from my GP to partake in the retreat activities as detailed on the website. I commit to promptly informing Retreat Scotland of any alterations to my health and fitness status outlined in this questionnaire prior to engaging in the retreat. I acknowledge having comprehensively read, grasped, and truthfully answered the questions. I am aware that participating in these activities carries the potential risk of injury, including the unlikely event of fatality. Additionally, I assert that I am willingly participating in a recommended and appropriate level of exercise.

Yes

I understand that any activity partaken outwith the Retreat Scotland activities during my stay, i.e. going for walks alone, using third party suppliers facilities or with other group members without Retreat Scotland staff present, or renting bicycles or using anything that do not belong to Retreat Scotland, I do so at my own risk and waive all liability and responsibility for my health and safety to my own personal risk and not that Retreat Scotland owners or staff*

I Agree

I understand that Retreat Scotland and other guests take photos and videos that are used on social media. I agree that my permission is required to tag any photos and understand unless we request to be tagged, any social media WILL NOT be tagged to my private socials.

I Understand/Agree

I agree to only take part in what I feel comfortable with and my choices are my own.

I Agree

I agree that I have read /spoke with Retreat Scotland, read the website and all T&Cs and confirm I fully understand what I am participating in.

I Agree

As a participant in Retreat Scotland, I hereby authorize the confidential retention of this questionnaire by Retreat Scotland for its exclusive use, applicable to the upcoming retreat and any subsequent ones. I also confirm my intention to engage in activities, including aerobic exercise, resistance exercise, and stretching such as yoga, pilates, power walks, massage, swimming, guided walks, and hikes, at my own risk. I release Retreat Scotland and its staff from any liability. The information I've furnished is truthful, and I acknowledge Retreat Scotland's right to assess my health form and cancel my booking if the responses are inconsistent with the health-related booking terms and conditions.*

I Agree

Health Form