Pregnancy & Infant Loss Retreat

Please take a few minutes to complete this form prior to the 2nd of October to help us support you.

Name

First Name

Last Name

Phone number

Emergency contact name & number

Dietary requirements

Grazing platters will be shared please indicate any dietary requirements and preference for milk alternatives

Body injuries or conditions

We will share a gentle Yoga practice together. Do you have any injuries or conditions relevant to Yoga movement? (blood pressure/spinal issues/pregnancy)

Yoga Liability

I consent to hands on touch and body and energy adjustments by the teacher and facilitator to aid my practice and healing

I understand I am fully responsible for my own body and I take personal responsibility to participate in a way that looks after my body

I consent to the use of essential oils, sage and palo santo

If you would like to share your loss or experience you're invited to do so here or please provide any other relevant information or comment