Registration Form

Please complete the form below – fields marked with * are mandatory.

    Full Name*

    Age*

    Address*

    City/Town*

    Postal Code/Zip*

    Telephone Number*

    Email*

    Room preferences:*
    (ie: Private Room (single), Semi-Private (couple sharing bed or 2 singles)

    Emergency Contact*

    Emergency Contact's Phone Number*

    How are you connected to your emergency contact?*
    (ie: partner, parent)

    Previous Yoga Experience*
    (ie: briefly describe your current practice frequency, years of practice)

    Please list any dietary restrictions*

    Please list any medications or conditions we should be aware of*

    What benefits are you expecting from your retreat experience?

    Any other comments or questions? We'd love to hear them! How did you hear of Retreat?