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* 1. Name

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* 2. Email & Phone Number

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* 3. Emergency Contact Name & Phone Number

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* 4. Please list an dietary restrictions

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* 5. Preferred Housing Request

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* 6. Any Roommate Request?

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* 7. List any injuries that we should be aware of.

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* 8. I acknowledge that I am signing up for a Yoga Retreat that includes physical exercise and group activities. I will not hold HEART & GRIT Power yoga, the program facilitators, Seven Oaks Retreat Center or any of the above mentioned employees or contractors responsible for any accidents, injuries, or incident with your personal property.  I also acknowledge that my deposit is 100% non-refundable. Travel insurance is recommended.

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* 9. Select your shirt size

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