Student Registration Form s1

2WiseWomen Mangrove Yoga Retreats with Coralie Casey & Mary Woolley 2018 Registration Form To ensure that the course sessions are safe and appropriate to your needs, please complete the following questionnaire. All information will remain confidential and is designed to help your instructors understand how they may help you throughout the sessions. Please feel free to speak to Coralie and Mary about any conditions you may have. (circle or tick where appropriate) Mr/Mrs/Miss/Ms:______First Name:______Surname: ______Address:______Suburb: ______Postcode:______Phone (H): ______(W): ______(M): ______Email: ______Date of Birth: ______Emergency Contact Name & Phone: ______

1.a. Please advise any existing health conditions e.g.

rBlood Pressure – High or Low rBack Conditions (e.g. Lower, Middle, Upper or other conditions such as scoliosis or whiplash) rMuscle, joint or tendon problems (e.g. Shoulders, Knees, Hips – Other) rRespiratory Ailments (e.g. Asthma, Emphysema, Bronchitis, Other) rRecent Surgery or Injury rAllergies rDiabetes rIf pregnant please advise: - How many weeks ______Due Date ______rMental Health e.g. depression/anxiety etc rCancer rOther conditions, please specify. ______If you ticked any of the above health conditions, please advise further details of these conditions (write on a separate sheet if necessary)

1.b. Are you currently taking medication or receiving treatment for any of the above? YES / NO (if yes, please specify the form of medication/treatment & if you have approval from your health care practitioner to undertake a yoga practice)

2. Have you any yoga experience? (NO experience is required – it just helps us plan the classes) YES / NO If yes, please give a brief outline of your experience

3. Do you have any special dietary requirements? YES / NO. If YES please circle relevant requirement. Dairy Free / Gluten Free / Vegan / Other – please specify______I acknowledge that the instructions given throughout the sessions are given only as guidance and are not intended to replace medical care. I therefore accept that it is my responsibility to advise the instructors of any existing conditions including any recent injury, illness, surgery or commencement of pregnancy; in order for them to assist me to adapt the practices for my needs. I acknowledge that it is my responsibility to do the practices within my own limits to prevent injury and expressly waive any claim I may have against Coralie Properjohn and Mary Woolley and any other staff or volunteers representing 2WiseWomen for any injury or loss sustained by me resulting from the practice of Ayurveda or Yoga under their instruction.

of 4 2WiseWomen Mangrove Yoga Retreats with Coralie Casey & Mary Woolley ______Retreat & Accommodation Preference (prices per person) □ You, your Hormones & the Moon – 18-21 January 2018 (Thur 3.00pm – Sun 3.30pm)

□ Tent (provide own camping gear): $485 pp □ Shared room (3 people): $575 pp □ Shared room with Ensuite (3 people): $650 pp (only 5 ensuite rooms available) □ Twin share: $650 pp □ Twin with ensuite: $680 pp (only 5 ensuite rooms available) □ Single room: $725 pp □ Single with ensuite: $785 pp (only 5 ensuite rooms available)

You have the option to bring your own bedding or hire a Bed pack (sheets/blankets/pillow/towel). □ Bed pack - $30 pp: □ I will bring my own bedding

Payment Method By Direct Deposit via Internet or Cheque

Account Name: Coralie Casey or Mary Woolley BSB: 637000 Account No: 721126714 Reference: Your surname and the month of the retreat e.g. smith_april2018 Please email: [email protected] when you have transferred your payment so we can confirm.

By credit card Trybooking link . Please note that a 2.5% surcharge has been added to cover credit card charges.

Terms & Conditions  Cancellations up to 10 days before the retreat commences will receive a refund (less a $75 administration fee).  Cancellation within 10 days of the retreat commencing will receive a credit (less a $75 administration fee) towards another 2WiseWomen programme.  There will be no refund in the event of late arrival or early departure.  If a program is cancelled by the organisers, all payments made towards the workshop will be refunded in full. The organisers will not be held responsible for any travel expenses which may be incurred in preparation for any workshop, including airline tickets, travel delays, flight cancellations or illness

DISCLAIMER for Courses with Coralie Casey & Mary Woolley It is acknowledged and agreed as a condition of participating in the services and activities including accommodation and related services, that the operators, occupiers, instructors and their employees, agents, contractors and volunteers shall not be under any liability for death or any personal injury, loss or property damage which may be sustained or incurred to any person at any of the workshop/retreat venues or any adjoining or related lands. I (the undersigned) agree to the Terms & Conditions and take full responsibility for my actions while traveling to and from the course venue and during my time at the venue. I acknowledge that I am fully responsible for myself during my stay or when participating in any activity.

of 4 2WiseWomen Mangrove Yoga Retreats with Coralie Casey & Mary Woolley ______Name:______Signature: ______Date: ______

Please return the signed form via e-mail to [email protected]

of 4 2WiseWomen Mangrove Yoga Retreats with Coralie Casey & Mary Woolley ______Preparing for the retreat & staying at Mangrove Yoga

Preparing for the retreat: Mangrove Yoga is coffee and tobacco free within the grounds. To minimize any discomfort this may cause you can try to wean yourself off using the 1⁄4 rule. Reduce your intake by a 1⁄4 the first week, then by a 1⁄4 the next week and so on and/or bring some Panadol with you.

What to pack: Shoes are removed in the practice areas so slip-on sandals/shoes are useful. You can bring your own bedding or hire a bedding pack for $30. See website. for other suggested items

Contact Details: During the retreat, you will be staying at: Mangrove Yoga 300 Mangrove Creek Road Mangrove Creek, NSW 2250 Tel: (from Australia 02 43774499) http://www.mangroveyoga.org

Getting there: You can find travel information and directions on the Mangrove Yoga website. If you are using a GPS DO NOT turn right onto Pemberton’s Hill Road off Wiseman’s Ferry Road – it leads to a dead end. Instead follow Wiseman’s Ferry Road down for another 7-8 minutes and turn right onto to Mangrove Creek Road.

Your accommodation is available from 3.00pm on Thursday afternoon and the course programme begins at 7.00 pm that evening.

What to expect Your day begins with a morning yoga class at 5.30am and finishes at 8.15pm. In addition to the 2WiseWomen workshops and classes the programme also provides the opportunity to participate in the Mangrove Yoga’s traditional yoga practices including morning Karma Yoga circle, Havan (fire ceremony) on Saturday afternoon and Kirtan (call & response singing) on Saturday night.

There are spaces in the program for quiet/reflection time. Please use those times in a manner that respects the needs of others and maintains the energy of the space.

Check-out The programme finishes with afternoon tea on Sunday and you are welcome to remain for rest of the afternoon and enjoy the beautiful grounds. If you do stay on it would be appreciated if you could pack up your room after lunch.

If you have any questions or feedback please contact us via [email protected] or call Coralie on 0474 226 448.