Higher Potential Living Retreat Registration

Classes
Training
Events
- Retreats >
  - Upcoming Retreats
  - Past Retreats
Shop
Beyond the Mat
- Jason Maraschiello
- Laurin Wolf
Virtual Studio
- Free Video Classes
- VIP Lounge >
  - VIP Content
About
Book a Class

Higher Potential Living Retreat Registration

To register for this Retreat, please provide all required information through the form below. In order to book your space in the Retreat, we must have your Registration Form as well as your payment. Please use the button below the form to submit your payment. If you require financial assistance please contact us to make other arrangements.

Please note we must have a separate Registration Form and payment for each participant. Thank you!

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Gender Association (for sleeping arrangements) *

Roommate Request (Full Name) *

Do you wish to share a bed to receive the discounted rate? (Private Room, ideal for couples or friends) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

How did you hear about this Retreat? *

Internet Search Advertisement Friend Other

If Other please specify: *

What is your age? *

16-18 19-25 26-35 36-50 Over 50

What is your experience with Mindfulness/Meditation? *

Have you ever been to a Yoga or Meditation Retreat before? *

What is the main reason you are attending this Retreat? *

What do you hope to get out of this weekend? *

Health Form

Our menu for the weekend will be simple, healthy and delicious vegan creations! Please list any allergies on the Health Form below.

Do you have any allergies (food or other)? *

Type of reaction: *

Date of last reaction: *

Medication/Treatment for allergy: *

Do you have any other health concerns or dietary restrictions? *

Please list/describe any injuries, conditions or areas of concern: *

Please provide an Emergency Contact:

Name *

First

Last

Phone Number *

Relationship to participant: *

Waiver Form

If at any point in time during your Kala Yoga Retreat, you feel strain, discomfort or pain in an activity, please take rest as needed. You may rest at any time during the class. It is important in Yoga that you listen to your body and respect its limits on any given day, as this can change.

I, the undersigned, understand that yoga & meditation are not a substitute for medical attention, diagnosis or treatment and that I should consult a physician regarding any concern I may have prior to starting a new activity program – including yoga practice. I recognize that it is my responsibility to inform the instructor of any concerns, physical injuries/limitations, or serious illness before the start of each class. During the Retreat, I will not perform any activities to the extent of strain or pain.

I, the undersigned, recognize that it is my responsibility to inform the instructor of any concerns, physical injuries/limitations, or serious illness before the start of the weekend. I have also advised above of any existing injuries that I have. I understand that the information given above is personal, and will not be shared with any third party, but may be recorded on my file for safety reasons.

I understand that the instructors, facilitators and facility coordinators of Kala Yoga are not liable for any damages or injury to person or property, resulting from attending a Kala Yoga Retreat or participating in any activities hosted by Kala Yoga staff. I am responsible for my own safety.

Please indicate you have read and agree to the above: *

I agree to the above terms.

Name *

First

Last

Date *

Submit

Payment

The cost for this Retreat is $375 plus HST per person. We also have two private rooms, where if you choose you can share a bed with another participant and pay $300 each (please indicate on above form if you would prefer this option). For this option payment must be made together, $600 total.

Please submit payment using the button below to pay via Credit Card or Visa Debit. If you wish to make payment another way, please contact us (we can also accept E-Transfer, or you can make a payment at the Studio via cash or cheque. Thank you! We are so excited to have you joining us for this Retreat!

Pay for One Person

Pay for Two People

What to Bring

Once you have registered, please download the file below for a list of what items to bring, as well as check-in/out times, etc. Please don't hesitate to contact us with any questions or concerns!

You will also be sent a reminder email with any additional information the week before the Retreat. Thank you for joining us, we can't wait to spend a mindful weekend with you!

What To Bring
File Size:	177 kb
File Type:	pdf

Download File

SEE YOU ON THE MAT! NAMASTE

EMAIL ADDRESS
info@kalayoga.ca

PHONE NUMBER
519-938-8848

PHYSICAL ADDRESS
229 Broadway
Orangeville, Ontario, L9W 1K4

NEWSLETTER SIGNUP

* Indicates required field

Email *

HOURS

Monday - Thursday

9:30 AM to 11:00 AM
5:00 PM to 9:00 PM

Saturday

9:00 AM to 11:00 AM

Sunday

9:30 AM to 12:45 PM
5:30 PM to 7 PM