Soft Reset Booking Form

Thank you for choosing RestRetreats.

RestRetreats is a warm and friendly wellness retreat service where wellness meets health — a space created for you to feel mentally and physically free from the pressures of work and personal responsibilities. Here, both body and mind are given space to breathe, relax, and tune inward, helping you reset and create a new sense of balance and clarity.

No matter where you are in your well being journey, you are invited to reflect, reconnect, and rediscover what truly supports you. Through mindful movement, stillness, and guided practices, we aim to create a supportive, safe, and inclusive environment for all guests.

Please complete this form to confirm your retreat booking.

Wellness – Movement – Mindfulness Care

General information

First Name

Last Name

Date of Birth

Address

Postcode

Mobile

Emergency Contact (Next of Kin):

Emergency Contact Phone:

Relationship:

PAR-Q (Physical Activity Readiness Questionnaire)

Please answer the following:

Health & Wellbeing

1 Do you have any medical conditions we should be aware of? 2 Have you experienced chest pain during physical activity? 3 Do you have any joint, bone, or mobility issues? 4 Are you currently taking any medication that may affect your ability to exercise? (Yes/No) 5 Do you have any injuries or recent surgeries? 6 Are you pregnant or recently postpartum?

Par-q

I understand

I understand that RestRetreats does not provide medical advice, diagnosis, or treatment

Health Declaration

I confirm that I am physically fit and able to participate in physical activity. I understand that it is my responsibility to consult a healthcare professional if I have any concerns about my health.

Participation & Responsibility Agreement

Health para

I understand that I am voluntarily participating in activities organised by Rest Retreat, including but not limited to:
• Pilates and movement sessions
• Meditation and sound therapy
• Outdoor activities I agree to:
• Participate at my own pace and within my limits
• Inform the coach of any discomfort or issues immediately
• Take full responsibility for my own health and wellbeing during the event

Liability Waiver

I acknowledge that participation in physical and wellness activities carries a risk of injury.

Liability & Agreement 2

I agree that Rest Retreat, its coaches, staff, and affiliates shall not be held liable for:
• Any injury, illness, or accident
• Loss or damage to personal belongings
• Any incident occurring during or after the event

I accept full responsibility for my participation.

Dietary & Allergy Disclaimer

I understand that food provided is halal and vegetarian-friendly.

Dietary & Allergy Disclaimer

I confirm that:
• I have disclosed any allergies or dietary requirements
• I am responsible for managing my own dietary needs
Rest Retreat cannot guarantee an allergen-free environment and accepts no liability for allergic reactions.

Dietary & Allergy Disclaimer

Media Consent

I understand that photos and videos may be taken during the event for promotional purposes.

Media Consent

I consent to being photographed/filmed  I do not consent

Agreement

Media Consent

I confirm that:
• All information provided is accurate
• I have read and understood this form
• I agree to all terms outlined above

Participant Name

Signature

Todays Date