Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Birth Date

Special Diet Requests

Emergency Contact Information

Any medical/health concerns?

How did you hear about this retreat?

Style and Level of Yoga Practice

I practice a few times a week. I practice on and off. Beginner level or more advanced? You prefer restorative or vinyasa flow?

List any injuries or ailments

Please include any conditions you have been diagnosed with, depression, anxiety, and physical trauma (broken bones, surgeries, etc.)

Are you travelling with a friend whom you'd like to share a room with?

Signature

*Non-Refundable $200 to reserve your spot *Balance Due by Feb 9th, 2019 Cancellation Policy Full refund, minus $200 non-refundable deposit, before Oct 15, 2019. 50% refund, minus $200 non-refundable deposit, before Dec 15th, 2019. 0% refund after Dec15th, 2019.

Cancelation Policy

Full refund, minus $200 non-refundable deposit, before Oct 1st, 2019. 50% refund, minus $200 non-refundable deposit, before Dec 1st, 2019. 0% refund after Dec 1st, 2019. $200 Deposit Due to secure your spot. Balance due by September 1, 2019

I agree to the Cancelation Policy

Liability Waiver

Terms and conditions 1) I have read and understand the information on the Magnolia Grove Monastery website about this retreat and attending retreats at Magnolia Grove. 2) I have read and understand the Cancellation Policy for this retreat. 3) I am are aware that each individual is responsible for their own well-being, and that of any minor(s) in their care. 4) I understand that meditation practice is a complement to, and not a substitute for, prescription medicines, or any psychological or medical treatment. I intend to continue to follow the direction of my doctors and counselors. 5) I agree to relieve Magnolia Grove Monastery from any and all liabilities in the event of any accidental injury or illness incurred by me, or by any minors in my care.