Divine UK

Residential Retreat Stay Form

Personal Details

Select Retreat

Retreat Start Date

Retreat End Date

For Participant 1

Select a Title

First Name

Last Name

DOB

Are you below 18 years of age ?

Add More Participants ?

For Participant 2

Full Name

DOB

Gender

Allergies and Medical Condition

Are you below 18 years of age ?

Phone Number

Address

Post code

Country of Residence

Are you traveling from outside the UK?

Current passport issued by

Are you legally entitled to stay in the UK?

Yes

Type of Visa

When do you plan to arrive ?

Other Details

Emergency Contact

Name

Relationship

Phone Number

Address

Do you have any criminal convictions?

Yes

We need to keep the information you give us in this form. We will not share the information with anyone else without getting your permission first, or making you aware

I agree with terms and conditions as well as Short term Accommodation Agreement shown in the above box.

By ticking this box, I am giving permission to store this information on file, and on computer

GDPR Disclaimer
By completing this form, you agree to the processing of your personal data and it will be used for [specific purposes, e.g., managing volunteer participation, event coordination, communication about our services]. We will not share your personal data with third parties without your explicit consent, unless required by law.

Signature

Pay Now: Advance £20 per participant for securing the booking and balance £55 payable at the centre (Total £75 per participant)

Total: £20 (1 Participants)