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REQUIRED INFORMATION

Wim Hof

MENU CHOICES 

Please see here for the event menu. Let us know your choice in the box below and any allergies/dietary requirements. Please note that we cannot amend the individual dishes based on personal preferences. If you have questions please contact us before completing the form.

MEDICAL HISTORY

Please note that the below details, including your name, will be shared with the workshop facilitator in order for them to assess the suitability of this workshop and whether special considerations need to take place. Your details will not be shared for any other purposes.
Are you currently fit and healthy?
DO YOU SUFFER FROM ANY OF THE BELOW CONDITIONS?

PERSONAL LIABILITY STATEMENT
Belinda Raphael is a certified is a certified Wim Hof (WHM) Instructor and will see to it that the WHM activities are carried out  safely and correctly. However, we cannot assess the health risks particular to individual participants. If you have any health conditions, it is your personal responsibility to consult a doctor prior to participating in any Wim Hof activities. It is ultimately up to you as the participant to determine whether you are fit to take part.

"I hereby declare that I participate in the Wim Hof Method Fundamentals Workshop voluntarily and entirely at my own risk. I hereby declare that I have been adequately informed about the particulars of the WHM workshop beforehand, and that I am in good physical and mental condition. I shall not hold Belinda Raphael liable for any damages and/or injury resulting from participation in the Fundamentals Workshop’’.

 

PLEASE SIGN  + DATE BELOW

Thank you for submitting our pre-workshop questionnaire.
We look forward to seeing you soon!

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