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Next of Kin *

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Are any of the following relevant to you?

As a precaution, the following conditions may require special attention when do the breathwork or trauma-releasing exercises.

Pregnant

Recent surgery

EMDR treatment

High Blood Pressure (not controlled with medication)

Cardiovascular disease including angina, previous heart attack or

Asthma (if asthmatic, bring inhaler)

Epilepsy

Detached Retina

Glaucoma

Diagnosis of aneurysm in the brain or abdomen

Uncontrolled thyroid conditions and diabetes

Fibromyalgia, Chronic Fatigue, ME or Migraines

none of the above

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Your details, information entered and contact details are strictly confidential. They will only be kept within the The Grief Space organisation to decide on your suitability for our retreats. Choose yes if you agree to the storing and processing of your data.

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Do you sign and agree to the following statement?

I understand that the retreat is not intended as a substitute for medical or psychotherapeutic care. I understand that I undertake other activities, including breathwork, dance, meditation, yoga, etc. at my own risk. I have read and agree to the conditions with regards to your cancellation policies. I certify that all information provided on this form is true and complete. I understand that the admission to the retreat is based on some of the information provided on this form to ensure the safety of all participants and that any untruthful or inaccurate answers could lead to risks to myself or other participants.

I agree