Healiing Your Life: Ayurveda and Yoga 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*

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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 *
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 *
Are you pregnant	Pregnant?Due to the nature of the course we cannot accept those who are pregnant
How did you hear about us? *
If Other, then please tell us how you heard about us
Have you previously visited the Yoga Farm? *	If yes, please let us know when was the last time
Sivananda TTC Graduate? *	yes no
If yes, please tell us year and location *
If no, then please tell us which 200 hour training you have completed and which year? *
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.
Reasons for attending the course
Medical Issues	Enter "none" if you have no issues
Comments or Special Needs
Special Diet
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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6 Help us make a difference.

$	General Donation This donation goes towards the general functioning of the ashram.
$	Siva Wellness Center
$	Ballantree Lane Road Improvement
$	Krishna Temple Roof structure
$	TTC Scholarship
$	SYHET Scholarship

7 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

Sub Total	$0

Donations	$0

Taxes	$0

0% Deposit	$0

Pay	Choose to pay a deposit or the full amount right now.

Due Now	$0 $0

	You will be asked for payment details in the next step. Click the button below to continue.

Sivananda Ashram Yoga Farm - www.sivanandayogafarm.org

1 Welcome

2 Accommodations / Pricing

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 Participant Information

6 Help us make a difference.

7 Payment