Booking Form – Mindful Retreats Thailand

First Name

Last Name

Phone

Country

Confirm Email

Gender

Date of Birth

Language Spoken

Retreat Dates

12 - 15 November 2024 29 December - 1 January 2025

Room Type

Shared Standard room Private Standard room Private Deluxe room

* After you are approved for the inquired retreat, a $5,000 THB/person non-refundable deposit will be required to book your spot.

If you have selected a Shared Room, are you attending with a friend or partner, who you would like to share with? Please enter name

HEALTH INFORMATION

Current Medical Conditions:

Medications:

Allergies:

Dietary Restrictions:

Recent Surgeries or Injuries:

Other Relevant Health Information:

EMERGENCY CONTACT INFORMATION

Emergency Contact First Name

Emergency Contact Last Name

Relationship To You

Emergency Contact Phone Number

Emergency Contact Email Address

Do you have Health or Travel Insurance?

Yes No

Provide Name of Insurance Provider & Policy Number:

TERMS & CONDITIONS

Booking and Payments: A deposit is required to secure your booking. The full payment must be made in cash upon arrival at the retreat centre. Cancellation Policy: Deposits are non-refundable. However, if you are unable to attend, we allow transfer of your deposit to a future retreat date within one year of your original booking. Participant Conduct: Attendees are expected to respect the retreat rules and fellow participants. Disruptive behavior may result in removal from the retreat without a refund. Liability Waiver: All participants must sign a liability waiver releasing Mindful Retreats Thailand from responsibility for personal injuries or losses that may occur during the retreat. Privacy Policy: Personal information collected during booking is used solely for retreat organisation purposes and is not shared with third parties. Health and Safety: Participants must disclose any relevant health issues prior to arrival. The retreat does not provide personal medical care. Changes to Retreat Schedule: Mindful Retreats Thailand reserves the right to make changes to the retreat schedule or facilitators as necessary.

I AGREE TO THE ABOVE TERMS & CONDITIONS

Yes No

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