Yoga and Meditation Long Weekend

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1 Welcome

2 Price

Please pay the full price if you can, to support Rivendell. Concessionary rate is only for people on a very low income You can make a deposit or full payment. Balance payments are due 6 weeks before a retreat.

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£339.00 – Full price

Number of Guests:

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£275.00 – Concessions price

Number of Guests:

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3 People in your group

4 Participant Info

Mobile Phone / Phone *	Please provide a mobile phone number if possible
If we need to contact you regarding your booking, How can we contact you? *	Email (we will usually use email) Phone Call Whats App Text Please select which methods you consent to us using - EMAIL is our main method
Address line 1 *
Address line 2	Optional Secondary line of address
Town / City *
County *	e.g East Sussex, Kent etc
Postcode / ZIP *
Country *
Have you attended a retreat at Rivendell in the last 5 years? *	Yes No
Triratna Buddhist Community Experience *	I have no previous experience of Triratna Buddhist Community I attend a Triratna centre / activities occasionally I attend a Triratna centre activities regularly I am a Mitra I am an Order Member
Triratna Order Name *	If you are ordained in the Triratna Buddhist order please add your name here
Emergency Contact Name *	In case of emergency please provide details of someone we can contact on your behalf:
Emergency Contact Relationship *	Please let us know the persons relationship to you: e.g Friend, Partner, Family member
Emergency Contact Phone *	Please add the telephone number of your Emergency Contact
I agree to share a room *	Please tick this box to confirm you understand that you will be sharing a single sex room
Single room	Due to the layout of the building we are usually only able to offer 1 single room which is allocated to those with disability or a medical health condition. Special accommodation requests cannot be guaranteed, however we will do our best to accommodate according to needs. Contact us if you need to discuss your needs in more detail.
Request for a single room	If you need to request a single room, please give us the reason for your request, thank you.

5 Communications

Booking deposit policy *	I understand Rivendell's non refundable deposit policyAll deposit amounts are non-refundable and non-transferable in all circumstances.
Terms and Conditions *	I accept the terms and conditions.Please read the terms and conditions and booking policies
Cancellation policy. *	I accept the following cancellation policy:
Cancellation information	Cancelling more than 6 weeks before a retreat: full refund minus the deposit. Cancelling 4 to 6 weeks before the retreat: if we can fill your place, full refund minus the deposit: if we can't fill your place, half refund minus the deposit. Cancelling less than 4 weeks before the retreat: any refund will be at Rivendell’s discretion, depending on circumstances. Please let us know as soon as possible if you need to cancel, as there may be other people waiting for a place on the retreat to become available.
Continuity and attendance *	I understand Rivendell's attendance policy and can attend the entire retreat.Continuity is an important aspect of being on retreat. It is disruptive to the atmosphere of a retreat to arrive late, leave early or to take excursions. Please tick box to confirm that you understand Rivendell's policy on continuity and can attend the entire retreat.
Any questions?	Have any questions? Read our FAQS here or Contact us
Email newsletter	Please send me the monthly email newsletter
How did you hear about us? *

6 About you and your current Health

Your age *	I confirm I am aged 18 years or over
What will your age be at time of retreat	Optional...but may be helpful for us to know
Gender *
Are you pregnant?	If you are pregnant please tick
What stage is your pregnancy?	Please note if you are due to be in your first trimester (first 3 months) of pregnancy at the time of the retreat it will not be suitable for you to attend. Please contact Rivendell/the yoga tutor if you are pregnant and if you have any questions.
Your current health condition	Please fill out any details you think we need to know about your current health condition. Any information given will not be given to other retreatants and is treated in strictest confidence and only shared with Retreat leaders/team members that would need to know for legal/health reasons.
There are a few contra-indications to the practice of Yoga on these retreats.	Please tick if you experience any of these contraindications. In some cases these conditions may not be so severe as to prevent attendance on the retreat. Anyone who suffers from such a condition should consult their own doctor. Please note by booking on this retreat you acknowedlge that you are declaring to be well enough to attend in accordance with our policies.
Contraindications : Please select any condition you experience	Severe physical disabilities. Hypertension or raised blood pressure Low blood pressure Other conditions associated with heart disease Serious Back Pain Meniere’s disease or similar conditions in which disturb balance control of the body Epilepsy (including petit mal) which, may be aggravated by deep breathing or hyperventilation of the lungs in any position. Diabetes. Any other health condition which needs to be mentioned
More details about your physical health	Please give any more details about any physical health condition
Are you under any form of medical treatment? *	Yes No If so, please give details below
Medical health details	Please give details of any medical treatment you are receiving
Are there any emotional or mental health issues which could affect your participation in the retreat? *	No Yes Read more information here - Are you well enough to be on retreat?
Mental/emotional health details	Please fill in any other health information to inform the teachers.
Are you physically able to help out? *	Yes No Retreats at Rivendell include helping out with light domestic tasks; washing up, laying out for meals, etc and a clear up at the end of the retreat. Are there any limitations which may affect your ability to help out with basic domestic tasks?
Limitations on assisting on domestic tasks
Do you wear glasses or contact lenses while practicing yoga? *	No Yes - glasses Yes - contact lenses Please select appropriately
Do you have any Dietary restrictions *	No Yes Rivendell provides a well balanced vegan diet. Sorry we are unable to provide non vegan food here. If you have diet restrictions for genuine medical reasons please select 'Yes' and you can add further details. If you have further questions please contact Rivendell.
Special diet information	Please provide details about your restricted diet. To help our volunteer cooks, please keep special food requests to absolutely essential requirements only. Thank you.

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7 Donate to our bursary fund

£

8 Security Check

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9 Payment

Sub Total	$0

Donations	$0

Taxes	$0

Deposit	$0

Pay	Choose to pay a deposit or the full amount right now.

Due Now	$0 $0

Choose Payment Option

	Important: please quote the name you used to book the retreat as the reference for payment. Account name: Rivendell Buddhist Retreat Centre Sort code: 089299 Account no: 65425798 Your registration is only complete and confirmed once payment is received. Click on the button below and these instructions will be repeated on the next page.

	You will be asked for payment details in the next step. Click the button below to continue.

Guest 1		First Name / + Order name if ordained* Last Name* Email*
Guest 1		First Name / + Order name if ordained* Last Name* Email*