Please complete the following registration form for Patanjali Wellness Retreat in full. You must complete one form for each guest.

This form will refresh once submitted, alternatively you can send the link to this form to your guests: www.pypt.org.uk/wellnessretreatform

Title

Mrs

Miss

Name

First Name

Last Name

Date of Birth

Marital status

Home address

Please include postcode

Phone

Country

(###)

###

####

AYT Level 1 Certificate Number

Do you have any health conditions?

Yes

If 'Yes' do you have permission to travel to India from your doctor?

Yes

Declarations

DECLARATIONS I hereby declare the following:  I agree to teach Yog and Pranayam free for two hours per week.  All particulars provided in the above form are correct to the best of my knowledge.  I shall abide by all rules & regulations as detailed to me by PYPT (O&I) during the course of my stay.  I shall abide by the code of conduct of Patanjali Yog Peeth (UK) Trust as prescribed for Yog Teachers / Volunteers / Students by PYPT from time to time.  I further understand that PYPT shall not be responsible for any losses even if the schedule have to be changed due to unavoidable conditions.  I understand that the accommodation provided in Haridwar shall be basic & on a sharing basis.  I understand that I shall be responsible for my own well-being, and health & safety.

Passport details

OCI details

Only required for holders of The Overseas Citizenship of India visa

Visa details

DISCLAIMER FORM FOR ATTENDING YOG TEACHER TRAINING SESSIONS.

The Yog Teacher Training Sessions are run by a charity organization called, Patanjali Yog Peeth (UK) Trust who are hereby referred to as the Organizers & Instructors (‘0&I' in association with (A Yog teaching body of PATANJALI YOG PEETH TRUST, Haridwar, India). The Organizers & Instructors (‘O&I’) wliich expression shalI include all related entities (employees, agents,affiliates, volunteers associated with them) expressly state that, in general Yog-Pranayam is safe and beneficial but like any other health and physical exercise program it needs to be practiced judiciously, correctly and cautiously. No citing by O&I at the Yog-Pranayam.Classes to any hea!th- related/medical/other information isintended to be a substitute for professional judgment of a qualified health-care provider. The O&I are not subject or liable to change the structure of the Yog-Pranayam Classes to suit individual needs. Not all presentations at the Yog-Pranayam Classes may be suitable for everyone. If pain i s experienced anytime during the practice of Yog-Pranayam. it should be stopped immediately and a qualified health care professional should be consulted. The O&I a s s u m e no responsibility and will not be liable for any harm, injury, damage known or unknown or otherwise, that may result from any tort, negligence or from a breach of an express or implied warranty however caused or occurring during or after participation in the Yog-Pranayam Classes or while practicing anything presented therein. By participating in the Yog-Pranayam Classes the participant or the guardian who is responsible by law for the participant, hereby expressly and Willingly assumes all risks, full responsibility and liability for participating and practicing anything presented therein and forever waives and releases and agrees to defend, indemnify and hold the O&I harmless from and against any and all injuries (including death), damages and any other claims or demands, liabilities and settlements (including without limitation, legal and accounting fees) on or against the O&I for l o s s e s or damages, including, without limitation, direct, indirect, incidental, consequential or special damages, personal injury/wrongful death, resulting from or alleged to result from participating in or practicing anything that is presented in the Yog-Pranayam sessions. I, my heirs or legal representatives forever release waive, discharge and undertake not to hold the O&I in any way responsible for accident, injury or death which may occur during my participation in the Yog-Pranayam Classes. T h e O&I, at their sole own discretion reserve the right to deny participation at any time of the Yog-Pranayam sessions to any entity without assigning any reason whatsoever. RULES FOR PARTICIPATING IN YOG PRANAYAM - YOG TEACHER TRAINING SESSIONS 1.. I understand that it is my responsibility to consult and obtain consent from a physician prior to and r e garding my participation in the Yog-Pranayam Sessions, T r a i n i n g P r o g r a m , Health Programs or Workshops.  Suitable clothing is advised e.g. loose gym wear/jogging wear/Punjabi suit.  Participants will bring their own Yoga mats/bed sheets, towels, tissues and drinking water (if required).  We do recommend that participants maintain a regular medical check up to see for themselves how Yog- Pranayam may be affecting their health within the medical parameters of concern (if any) or of those being monitored.  Participants are advised to come on an empty stomach for maximum results (No food 5 hours before the Yog- Pranayam Session) O&I highly recommends to every participant to consult and obtain independent medical ad vice from their Health Care Professional before executing the aforesaid disclaimer and become aware of any effect that may be applicable in light of your medical history or concerns. I acknowledge that I am participating in the Yog Teachers training sessions on voluntary basis. I have read, understood in its entirety and I voluntarily agree to the terms and conditions of the release and waiver of liability and rules for participating in yog-Pranayam training sessions as described above.