Wild Women Day 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. Payment should be made in cash the day of the Retreat. If you require additional financial assistance please contact us to make other arrangements.

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

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

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

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

Health Form

Our Community Lunch and Dinner for the Retreat will be potluck ~ each woman will be responsible for a portion of a meal (details will be emailed out). Please list any allergies on the Health Form below so that we can advise the other participants of any concerns.

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 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 Retreat. 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 a sliding scale of $50-80 per person. We want this experience to be affordable for all Women who wish to attend. Please bring cash for this Retreat with you on the day of the event. We are so excited to have you joining us!

What to Bring

Once you have registered, you will be emailed the details you need, including location. a list of what items to bring, as well as arrival 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 wild and wonderful day with you!