50HR Women’s SelfCare Application

Name *

First

Last

Email *

Phone (please include country code) *

Name you wish to print on your certificate *

Date of Birth DD/MM/YY *

Passport Number *

Nationality on Passport *

If you are currently outside of your country of birth, please share where and what has brought you there. *

Emergency Contact Name *

Relationship *

Email *

Phone (please include country code) *

How did you first hear about High Vibe Yoga? *

If referred, by whom? *

Is this your first training or retreat experience?* *

What interests you about this immersion? *

Do you have any medical conditions that may need attention during the training? Please list any medications you will be taking during the training. *

Diet: vegan, vegetarian, gluten free, dairy free, etc. *

Please list all food allergies: *

I agree to the following terms: *

I understand payments are non-refundable, unless the course is canceled by High Vibe Yoga or the Yoga Barn.
Refunds will be made in full less 15% administrative fee in the case of cancelation by the hosts.