Ayurvedic Massage Rejuvenation Retreat

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1 Welcome

3 People in your group

Guest 1		First Name* Last Name* Gender* Male Female Email*
Guest 1		First Name* Last Name* Gender* Male Female Email*

After completing this form, emails will be sent to everyone in your group to complete their information.

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5 Optional Items

Practical Ayurveda: Find Out Who You Are and What You Need to Bring Balance to Your Life

If you're looking for renewed energy, relief from stress, and improved sleep, this is the place to start. Practiced in India for millennia, Ayurveda reveals the path to ultimate well-being by identifying your individual characteristics and patterns of health and showing you how to bring balance to your life. Using this modern guide to conduct a simple self-assessment, you'll learn how to understand your constitution and patterns of health and bring balance to your life.

$22.99

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Ayurvedic Initial Consultation (90min)

Discover your own personal constitution and learn the basic tools to keep your body, mind, and spirit in balance through diet, lifestyle, and other tools for healthy living.

$165.00

1 Therapist Abhyanga (70min)

A profound restorative experience. This beautiful rhythmic full body massage uses warm herb infused oils specific to your constitution. Penetrates deep layers of tissue leaving you with a feeling of stability, warmth and comfort.

$135.00

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1 Therapist Bliss Therapy (2h)

Rejuvenate and energize the subtle bodies with a transformative and luxurious full body treatment that includes 3 holistic therapies flowing one after the other. First enjoy the Abhyanga, followed by the Shirodhara: a soothing stream of warm oil flowing over the third eye. Last comes Swedhana, a full-body herbal steam treatment.

$245.00

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6 Participant Information

All the information entered here will be kept private. Please fill out as much as you can. Required fields have a red *

Spiritual Name
Gender *	Male Female
Birth Date *
Marital Status
Languages Spoken
Arrival Time *
Departure Time *
Phone (mobile) *
Address *
Address 2
City *
State/Prov. *
Zip/Postal *
Country *
Emergency Contact Info - Name *
Emergency Contact - Address *
Emergency contact - Phone Number *
Emergency Contact - Secondary Number *
Emergency Contact - Email *
Emergency Contact - Relationship *

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7 Additional Information

How did you hear about us?
Sivananda TTC Graduate?	yes no
Yoga Experience	Please describe your experience with yoga and meditation
Occupation	Please describe your work history
Education	Please describe any formal or informal education experience.
Skills	Any additional skills that you think would be useful such as cooking, carpentry, gardening, landscaping, etc?
Reasons for attending the course
Medical Issues	Enter "none" if you have no issues
Sivananda Member?	Are you a member of a Sivananda Center, which one?
Comments or Special Needs
Special Diet

8 Agreements

Rules & Regulations	I have read and agree with the Rules & RegulationsPlease read the rules and regulations
Terms and Conditions *	I accept the terms and conditions.All deposits and payments made to Sivananda Ashram Yoga Farm are non-refundable unless canceled within 24 hours of booking. If you need to cancel or reschedule at any time after this initial period we are happy to accommodate you; your payments will be converted to an Ashram credit which you may use for up to twelve months from the time of cancellation for either course tuition or accommodations, or both.
Liability Release	I have read and accept the Liability ReleaseI, the undersigned, fully understand and agree to the following: 1. That I am participating in Yoga classes, workshops and/or courses offered by Sivananda Yoga Vedanta Center (SYVC), a nonprofit organization. I recognize that any physical exertion may be strenuous and may cause injury. I am fully aware of the risks involved. 2. I understand that it is my responsibility to consult with a physician prior to and regarding my participation in these classes, courses and workshops if I have any question as to my ability to participate in Yoga exercise/philosophy classes, meditations and other activities. 3. I hereby state that I am physically and mentally fit and have no medical condition which would prevent my full participation in these classes. Any medical conditions that I am aware of are listed or explained above. 4. I voluntarily participate in Yoga instruction taught by the Sivananda Yoga Vedanta Center. By signing my name on this form, I release the Sivananda Yoga Vedanta Center and its agents from liability for any injury to my person or damage to my property incurred while attending yoga classes online or onsite. I have reported any restrictive physical disorder to the staff and/or teachers of the Center.
Email newsletter	Please send me the email newsletter Do not send me the email newsletter

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9 Help us make a difference.

$	General Donation This donation goes towards the general functioning of the ashram.
$	Building Donation This donation helps the new projects at the ashram. Currently we are rebuilding the bathouse and building the krishna temple roof
$	TTC Scholarship donation This donation helps to support a student to take the TTC.

10 Payment

Credit card fee	I agree to cover the costs of processing this registration by paying the credit card fees. We are charged an average of 4% in payment processing fees. By offsetting a portion of these fees, you allow us to direct more of our revenue to offering life-changing programs and maintaining our beautiful property. When this box is checked, we will add 2% to your booking total. Thank you for your support..
2% Credit card fee	$0

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Sivananda Ashram Yoga Farm - www.sivanandayogafarm.org

Ayurvedic Massage Rejuvenation Retreat

1 Welcome

2 Accommodations / Price

Select an option*

Tent - Bring Your Own (female)

Tent - Bring Your Own (male)

Om Cabin - Private or book with a friend (2 twin beds)

Om Cabin - Double dorm share with another guest (2 twin beds)

Om Cabin - Private (1 twin bed)

Siva Cabin - Book with a friend (2 twin beds)

Siva Cabin - share dorm with another guest (2 twin beds)

Siva Cabin - Private (1 twin bed)

Krishna Cabin - book with a friend (2 twin beds)

Krishna Cabin, Double share dorm (2 twin beds)

Deluxe Shanti - Private or Married Couples (Queen Bed + Futon)

Deluxe Shanti - book with friends or family (3 twin beds)

Deluxe Shanti Shared Dorm (3 twin beds)

Deluxe Shanti - book with friends or family (2 twin beds)

Deluxe Shanti Shared Dorm (2 twin beds)

3 People in your group

4 Additional Programs

Participants

5 Optional Items

6 Participant Information

7 Additional Information

8 Agreements

9 Help us make a difference.

10 Payment