first name

surname

Email

phone number

street and house number

postal code and city

ABOUT YOUR PREGNANCY ABOUT YOUR PREGNANCY

How many weeks are you pregnant at the time of the retreat? How many weeks are you pregnant at the time of the retreat? 2nd trimester 26 - 30 weeks 31 - 34 weeks 34 - 38 weeks

Do you have pregnancy related complaints? Do you have pregnancy related complaints? yes no

yes, my complaints are ....

EXTRA INFORMATION EXTRA INFORMATION

Do you follow a specific diet or do you have allergies? Do you follow a specific diet or do you have allergies? yes no

if so, please tell us which diet you follow or allergies you have

Do you have injuries or complaints that are not pregnancy related, but that you think we should know about? Do you have injuries or complaints that are not pregnancy related, but that you think we should know about? yes no

which existing injuries do you have?

Is there anything else that you would like us to take into account? Is there anything else that you would like us to take into account? yes no

please let us know if there is anything you would like us to take into account...

Do you have any other questions? Do you have any other questions?

more information, wishes, suggestions, questions?

IN CASE OF EMERGENCIES IN CASE OF EMERGENCIES

name and number of partner in case of emergency

PLEASE PAY ATTENTION: when you click the registration button, you will be connected to Eversport. Here, you can complete the payment to finalize your registration. PLEASE PAY ATTENTION: when you click the registration button, you will be connected to Eversport. Here, you can complete the payment to finalize your registration.

first name

surname

Email

phone number

street and house number

postal code and city

ABOUT YOUR PREGNANCY ABOUT YOUR PREGNANCY

How many weeks are you pregnant at the time of the retreat? How many weeks are you pregnant at the time of the retreat? 2nd trimester 26 - 30 weeks 31 - 34 weeks 34 - 38 weeks

Do you have pregnancy related complaints? Do you have pregnancy related complaints? yes no

yes, my complaints are ....

EXTRA INFORMATION EXTRA INFORMATION

Do you follow a specific diet or do you have allergies? Do you follow a specific diet or do you have allergies? yes no

if so, please tell us which diet you follow or allergies you have

Do you have injuries or complaints that are not pregnancy related, but that you think we should know about? Do you have injuries or complaints that are not pregnancy related, but that you think we should know about? yes no

which existing injuries do you have?

Is there anything else that you would like us to take into account? Is there anything else that you would like us to take into account? yes no

please let us know if there is anything you would like us to take into account...

Do you have any other questions? Do you have any other questions?

more information, wishes, suggestions, questions?

IN CASE OF EMERGENCIES IN CASE OF EMERGENCIES

name and number of partner in case of emergency

PLEASE PAY ATTENTION: when you click the registration button, you will be connected to Eversport. Here, you can complete the payment to finalize your registration. PLEASE PAY ATTENTION: when you click the registration button, you will be connected to Eversport. Here, you can complete the payment to finalize your registration.