Undō Retreat

Name *

First Name

Last Name

Mobile number *

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Emergency contact's mobile number *

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Health & Safety *

I confirm I am over 18.

I understand that breathwork may not be suitable if I am pregnant, have uncontrolled epilepsy, cardiovascular conditions, or other serious medical concerns, and I have consulted my doctor if unsure.

I understand that this retreat is not a substitute for medical or psychiatric treatment.

I take responsibility for my own health and wellbeing during the retreat and will communicate with the facilitators if I need support.

Confidentiality & Group Agreement *

I agree to respect the privacy of other participants and treat all shared experiences as confidential.

I agree to respect the boundaries of others and participate in a way that feels safe for me.

Consent *

I consent to take part in all retreat activities to the extent that feels comfortable for me.

I acknowledge that my deposit is non-refundable and that the cancellation policy has been explained to me.

I have read, understood and agree to the breathwork waiver. You'll find it in the links section below the form.

Accommodation preference *

Individual room

Shared room

Payment reminder *

You can either secure your place with a deposit or pay in full for your preferred room now. If you’d like to pay the balance upfront, please tick the box below and we’ll send you an invoice. Otherwise, the balance needs to be paid by 31st December.

Deposit only

Full payment

Date

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