registration day RETReat 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 weeke 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 Ja, Ik meld me aan!
