Classical Indian Dance Weekend Retreat

Select Language:

...

...

* These fields are required

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*

5 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 *

6 Contact Information

Phone (mobile) *
Phone (landline)
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 *

7 Additional Information

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

9 Help us make a difference.

10 Payment

Sivananda Ashram Yoga Farm - www.sivanandayogafarm.org